Diagnostic Dilemma

Purpura Fulminans


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Question
A 3 years old boy is found to have dry gangrene of right index finger, left little finger and 2nd and 3rd left toe. He had fever for 3 months and an erythematous rash 15 days ago.

How to investigate cause of gangrene?
Expert Opinion :
This child has dry gangrene of the digits. Wet gangrene may suggest clostridium infection. Presence of dry gangrene is suggestive of occlusion of small arteries of hands and feet. Occlusion is due to a thrombus. Thrombus in small arteries may occur due to formation of microthrombi as in DIC, or due to vasculitis or due to anticoagulant factor defects. Cardiac emboli usually lodge in large or medium size vessels and not in small arteries. DIC may occur due to sepsis. Uncontrolled sepsis leading to DIC and gangrene should make one suspect underlying immunodeficiency or diabetes mellitus.

Vasculitis that can lead to microthrombi in small arteries are polyarteritis nodosa and antiphospholipid syndrome. Other thrombotic factor deficiencies such as Protein C & Protein S can also lead to microthrombi.

Thus, this child should be worked up for sepsis (Blood culture), DIC (prothrombin time, partial thromboplastin time, platelet count, D-Dimers), HIV, Diabetes mellitus, Antiphospholipid syndrome (APLA, ACLA), SLE (ANA, dsDNA), PAN (skin biopsy) and thrombotic deficiencies (Protein C & Protein S).
Answer Discussion :
P
Paddy Emmanuel
bubble
the use of x-ray, (CT) MRI,scan
1 month ago
U
ummuna saeed
bubble
autoimmune
1 month ago

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