Purpura in a 5 year old girl

A 5 year old girl presented with a one day history of fever, coryzal symptoms, and multiple skin lesions. She also reported abdominal pain and had vomited once. Physical examination revealed hypotension and multiple petechial bruises and purpura-like lesions over the four limbs and the face (fig 1⇓). Over 12 hours, the skin lesions evolved into irregular gangrenous purpura with a central dusky necrosis surrounded by fading redness (fig 2⇓). Blood tests revealed anaemia, thrombocytopenia, high C reactive protein, acute renal failure, and coagulopathy. Fig 1  Multiple petechial and purpuric lesions Fig 2  Irregular gangrenous purpura with a central dusky necrosis surrounded by fading redness 1. What is the most likely diagnosis? 2. How would you manage the most likely diagnosis? 3. What are the preventive measures? ### 1. What is the most likely diagnosis? #### Short answer Purpura fulminans caused by Neisseria meningitidis . #### Discussion Purpura fulminans refers to a rapidly progressive thrombotic disorder that manifests with disseminated intravascular coagulation, intravascular thrombosis, and haemorrhagic infarction of the skin.1 It can herald multiple organ failure and has a high mortality rate (10%~ >50%).2 The disease course is fulminant, and early recognition of purpura fulminans is crucial for successful treatment.2 The initial skin lesions can …