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Severe acquired purpura fulminans in a child
  1. Sophia Liniger1,
  2. Tobias Dantonello2,3,
  3. Miriam Diepold2,3,
  4. Christoph Aebi1,
  5. Justine Brodard2,4,
  6. Johanna A Kremer Hovinga2,4,
  7. Jochen Karl Rössler2,3,
  8. Mutlu Kartal-Kaess2,3
  1. 1Department of Paediatrics, University of Bern, Bern, Switzerland
  2. 2Department for BioMedical Research, University of Bern, Bern, Switzerland
  3. 3Division of Paediatric Haematology & Oncology, Department of Paediatrics, Inselspital, University Hospital, University of Bern, Bern, Switzerland
  4. 4Department of Haematology and Central Haematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  1. Correspondence to Dr Mutlu Kartal-Kaess, Division of Paediatric Haematology & Oncology, Department of Paediatrics, Inselspital, University Hospital, University of Bern, Bern, Switzerland; mutlu.kartal-kaess{at}insel.ch

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A 3-year-old previously healthy boy presented with a fever (39.5°C), tonsillitis, cervical lymphadenopathy and epistaxis. Laboratory testing showed elevated C reactive protein (73 mg/L/695.2 nmol/L), leukocytosis (16 G/L), mild thrombocytopenia (138 G/L) and anaemia (haemoglobin 96 g/L). Within 24 hours, he developed gross haematuria and progressive irregular purpuric skin lesions affecting the lower extremities (figure 1), an elbow and genitals, typical of purpura fulminans. Antimicrobial therapy with third-generation cephalosporin and clindamycin was initiated. Laboratory testing for acute bacterial, fungal and viral infections was negative. Coagulation tests revealed disseminated intravascular coagulation (DIC) with …

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Footnotes

  • Contributors SL: data collection, figures, writing (original draft); TD and MD: data collection, writing (review and editing); CA: data collection, literature search, writing (review and editing); JB: data collection, data analysis, writing (review and editing); JAKH: literature search, data analysis, data interpretation, writing (review and editing); JKR: data analysis, data interpretation, writing (review and editing); MK-K: literature search, figures, data analysis, data interpretation, writing (review and editing).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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