CLINICAL IMAGE
Purpura fulminans: an unusual complication of malaria
Alka SharmaI; Vishal SharmaII,* * Corresponding author at: 1819 Gobind Nagar, Chheharta, Amritsar, Punjab, India. E-mail address: docvishalsharma@gmail.com (V. Sharma).
IDepartment of Medicine, Government Medical College and Hospital, Chandigarh, India
IIDepartment of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
A 45-year-old male presented with history of fever for four days and a skin rash for two days. The rash was present primarily at the extremities and had progressed to acquire a blackish hue at the time of presentation (Figs. 1 and 2). The patient was febrile and had hepatosplenomegaly. On further workup, the patient was diagnosed to have Plasmodium falciparum malaria on peripheral smear and antigen testing. The fever responded to intravenous artesunate and oral doxycycline. The patient lost his second and fourth toes of the right lower limb.
Purpura fulminans is a cutaneous manifestation of disseminated intravascular coagulation.1 It most commonly is a result of sepsis related to meningococcal, streptococcal or other bacterial infection. On occasion, it has been reported with malaria or deficiencies of anticoagulants like protein C or S. The management includes treatment of underlying disease and the use of activated protein C.1,2 Cutaneous manifestations are unusual with malaria and purpura fulminans has been reported only occasionally with malaria.3,4
Conflicts of interest
The authors declare no conflicts of interest.
Received 24 April 2013
Accepted 30 April 2013
Available online 25 September 2013
- 1. Agarwal MP, Sharma V. Clinical images: purpura fulminans caused by meningococcemia. CMAJ. 2010;182:E18.
- 2. Bhardwaj N, Aggarwal S, Sharma A, Sharma V. Photoclinic. Streptococcal purpura fulminans. Arch Iran Med. 2012;15:115-6.
- 3. Sharma V, Singhal M, Sharma A, Kumar V. Febrile urticaria in a family: uncommon manifestation of a common disease. J Infect Dev Ctries. 2012;6:895-6.
- 4. Khaira A, Gupta V, Gupta A, Mahajan S, Bhowmik D, Tiwari SC. Rare presentation of a common disease of tropics. J Assoc Physicians India. 2008;56:721-3.
Publication Dates
-
Publication in this collection
17 Dec 2013 -
Date of issue
Dec 2013
