ACQUIRED PURPURA FULMINANS INDUCED BY ALCOHOL AND ACETAMINOPHEN - SUCCESSFUL TREATMENT WITH HEPARIN AND VITAMIN-K

Purpura fulminans is a rare syndrome of progressive hemorrhagic necros is of the skin that may present as a dermatologic emergency. It most c ommonly affects children during the convalescent phase of a streptococ cal infection or a viral exanthem.1 in adults, it may be associated wi th sepsis or acquired causes.2,3 Its pathogenesis has challenged physi cians for decades. It has been discovered that purpura fulminans is al most always associated with disseminated intravascular coagulation and can occur in subjects with inherited or acquired deficiencies of the protein C anticoagulant pathway. Patients with liver compromise may al so be potential candidates for coagulopathies secondary to hepatic dys function and impaired protein synthesis. It is widely recognized that individuals who consume alcohol on a long-term basis may develop sever e hepatotoxicity from ingestion of therapeutic doses of acetaminophen (500 to 1000 mg every 4 to 6 hours).4,5 We have observed a patient wit h chronic alcoholism in whom hepatotoxicity and purpura fulminans deve loped secondary to the ingestion of acetaminophen.