Acute Infectious Purpura Fulminans in a Living Renal Transplant Patient with Perioperative Diabetic Foot Ulcer

Abstract

 Acute infectious purpura fulminans (AIPF) is the most severe complication of septic shock, associated with disseminated intravascular coagulation by infection, rapidly progressing to ischemic changes in the extremities. We report a case of AIPF involving a living renal transplant patient with perioperative diabetic foot ulcer. The patient was a 68-year-old woman taking methylprednisolone and cyclosporin post-renal transplantation. She had a right foot ulcer which failed to resolve even after multiple operations, and so she eventually underwent a below-knee amputation. On the eighth postoperative day, she suddenly developed septic shock due to emphysematous pyelonephritis of the transplanted kidney, as well as ischemic necrosis of the extremities. She survived with her transplanted kidney preserved, but required further limb amputations.