Abstract
A 42-year-old male was hospitalized due to fever and generalized malaise. He was healthy, and past medical history included splenectomy 20 years previously due to a traffic accident. He presented with scattered petechiae on his face, obvious purpura on his extremities and ears, and no any signs or symptoms of shock. Laboratory findings revealed disseminated intravascular coagulation (DIC), liver dysfunction, and acute renal failure. After transfer from his local hospital and admission at our institution, he was diagnosed as acute infectious purpura fulminans (AIPF) from clinical manifestations and the etiology of infection. The etiologic agent was identified as Streptococcus pneumoniae both by a commercial kit for the antigen of S. pneumoniae present in the urine and by blood culture. Empirical antibiotics were administered for pneumococcal infection. Immediate anti-DIC treatment was initiated and included antithrombin, fresh frozen plasma (FFP), recombinant human soluble thrombomodulin (rTM), artificial ventilation and continuous hemodiafiltration. The purpuric lesions on his extremities and ears resolved the day following anti-DIC treatment. Thereafter, he recovered from DIC without any gangrene, no complications developed, and he was discharged about 1 month after admission. This experience indicates that FFP administered as a replacement for protein C and rTM could be a useful therapy for DIC resulting from AIPF.
