A UNIQUE CASE OF PURPURA FULMINANS IN THE SETTING OF MIXED SHOCK IN A TERTIARY CARE CENTER

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Purpura fulminans (PF) is a rare form of disseminated intravascular coagulation (DIC) that typically presents following bacterial or viral infections. It associated with high morbidity and mortality. Below we discuss unique case patient who was hospitalized for mixed shock in the setting PF1. CASE PRESENTATION: We present 34 year old African American male presented to our hospital altered mentation worsening facial swelling an assault two days prior after he punched face. On day treated lacerations discharged oral clindamycin from outside hospital.Upon arrival hospital, febrile, tachycardic, tachypneic, hypotensive, saturating normal. Labs showed lactic acidosis, acute kidney injury, elevated proBNP 30,000 lab markers suggestive early DIC. examination distress, diffuse swelling, skin sloughing, blistering around eyes lips, scleral edema without corneal involvement, no symblepharon conjunctival cicatrization. Due significant upper airway intubated. Echocardiogram (ECHO) depressed ejection fraction. He taken operating room management cardiogenic shock. Intraoperative ECHO demonstrated bisystolic failure, fraction 25%. Swan-Ganz catheterization normal pulmonary arterial pressures, central venous pressure, saturation low 60s. started on inotropes, improvement acidosis.He pulse dose steroids, intravenous immunoglobulin, broad spectrum antibiotics. His lesions over course few became necrotic developed reticular vasculitic lesions. Serologic, infectious, autoimmune workup were negative. Deep biopsy epidermal necrosis multiple vessels demonstrating thrombi, most consistent DIC.He had complete cardiac renal recovery. extensive nature his eschars, transferred burn center further treatment. DISCUSSION: leading fevers, hypotension2. Patients develop widespread thromboses multisystem organ failure. PF complication infection, commonly encapsulated organisms but can also certain infections2. Treatment includes managing underlying DIC3. In patient, suspect trauma introduced streptococcus pneumonia into bloodstream sepsis subsequent multi CONCLUSIONS: Although rare, recognition infectious idiopathic causes will lead expedited treatment improved This illustrates devastating outcomes PF. REFERENCE #1: Colling ME, Bendapudi PK. Fulminans: Mechanism Management Dysregulated Hemostasis. Transfus Med Rev. 2018 Apr;32(2):69-76. doi: 10.1016/j.tmrv.2017.10.001 [PubMed] https://pubmed.ncbi.nlm.nih.gov/29157918/ #2: Nasrullah, A., Javed, Tariq, U., Young, M., Moeen, Z., & Balaan, M. (2020). Rare Fierce Presentation Pneumococcal Sepsis. European journal reports internal medicine, 7(1). DOI:10.12890/2019_001373 https://pubmed.ncbi.nlm.nih.gov/32015972/4. Asif M, Quiroga L, Lagziel T, Ladd SB, Caffrey J. A Multidisciplinary Approach Severe Fulminans Burn Center: Series. Cureus. 2019 Aug 25;11(8):e5478. 10.7759/cureus.5478 https://pubmed.ncbi.nlm.nih.gov/31646137/ #3: Perera TB, Murphy-Lavoie HM. Fulminans. [Updated 2021 Jan 11]. In: StatPearls [Internet]. Treasure Island (FL): Publishing; Jan. https://www.ncbi.nlm.nih.gov/books/NBK532865/ DISCLOSURES: No relevant relationships by David Alter, source=Web Response Anne Marie Bonaguro, disclosure file Robert Citronberg; Monal Patel, Priyanka Shastri, Mohammed Siddiqui,