A Sinister Cause of Bruising in a “Well” Neonate

Neonatal purpura fulminans is a clinical entity characterised by echymotic skin lesions, consumptive coagulopathy and widespread micro and macro vascular thrombosis. This can be hereditary or secondary to acquired causes. Clinical presentation of hereditary Protein C deficiency can be solely limited to localised echymotic skin lesions in the early stage, with wide spread vascular thrombosis ensuing eventually, in the absence of timely Protein C replacement. A case of a neonate presenting with localised scalp ecchymosis at birth, that soon progressed to skin necrosis and renal vein thrombosis is discussed. The report aims to raise awareness among neonatologists regarding the need to consider this rare condition with potentially devastating consequences, while evaluating bruise-like skin lesions in neonates.