Trauma-Associated Purpura Fulminans in a Previously Healthy Child: A Case Report and Review of Literature from a Resource-Limited Setting
Keywords:
Disseminated Intravascular Coagulation, Gangrene, Microvascular Thrombosis, Nigeria, Paediatric Septic Shock, Purpura FulminansAbstract
Purpura fulminans (PF) is a rare but catastrophic thrombotic disorder characterised by rapidly progressive cutaneous necrosis, disseminated intravascular coagulation (DIC), and multiorgan dysfunction. Although commonly associated with meningococcal sepsis, recent evidences implicate a broader spectrum of bacterial and viral pathogens, including Staphylococcus aureus and β-haemolytic streptococci, usually following skin barrier disruption or trauma. Data from sub-Saharan Africa are limited. We report a previously healthy 4-year-old boy developed acute infectious Purpura fulminans (PF) following minor trauma to the left knee sustained during play. He presented about a week later, with high- grade fever, vomiting, and rapidly progressive petechiae with evolving ischemia and gangrene of the toes and features of multiorgan dysfunction. Laboratory findings were consistent with consumptive coagulopathy and systemic inflammation. Blood culture was sterile, likely due to antimicrobial exposure prior to sampling. The clinical course was strongly suggestive of a toxin-mediated bacterial septicaemia, most plausibly due to Staphylococcus aureus. The patient was managed with broad-spectrum antibiotics including vancomycin, blood product support, intensive supportive care, and close surgical monitoring. Limb perfusion recovered, and amputation was avoided with full recovery. This casehighlights the need for high clinical suspicion of trauma-associated infectious PF in the Nigerian child, with the consideration of broader infectious spectrum. It reveals the importance of recognition, early empiric coverage for toxin- producing organisms like Staphylococcus aureus, and coordinated multidisciplinary care for optimal outcome. Future research should consider pathogen-specific mechanisms, improved specific diagnosis even after antibiotic exposure, and pragmatic strategies for managing severe pediatric sepsis in low-resource environments.
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