Purpura necrotica; a possible clinical application of the Shwartzman phenomenon.

Case Reports Case 1. A female, aged five years, was brought to the out-patient department at the Royal Hospital, Wolverhampton, on February 24, 1943, on account of purpura, and was admitted at once. There was no previous history of illness. The present ilhlss began suddenly on February 17, 1943, with pains in the legs (which lastd for one week). Twodayslatertherewasswellingofbothankles which lasted for twenty-four hours and then disappeared, leaving a bruise. The next day bruising was noticed on the inside of the knees and on the buttocks, but the child went to school. When she happened to fall down the bruises were noticed and she was sent home, where she remained till she came to hospital four days later on account of a purpurc rash which had appeared in the meantime. On admission both legs and buttocks were covered with purpuric patches of a peuliar character, the remainder of the body being free apart from a few small isolated lesions, and the mucous membranes were not affected. When discrete these purpuric patches all had the same appearance. They were of all shapes; some were circular or oval, but there was a definite tendency toangularity, the appearances being precisely similar to those of the next case (see fig. 2). They were raised above the surrounding skin, with a definite edge, and had a black, haemorrhagic bulla at their centre. Their general appearance is best described as a haemorrhagic urticaria. In addition to the discrete lesions there were a few areas ofconfluence where one simply saw a large purplish-black area. The two largest were on the outside ofthe left buttock and thigh, and these lesions atuacted immediate attention on account of their remarkable shape. That on the thigh was