PURPURA FULMINANS - A DISEASE BEST MANAGED IN A BURN CENTER

Victims of purpura fulminans are overcome by a rapidly progressive and sometimes fatal course involving large amounts of tissue loss and mul tiple organ system failure, from 1986 to 1995, seven children ranging in age from 10 months to 19 years (mean, 6.2 years) were referred to t he Shriners Burns Institute in Cincinnati with purpura fulminans. Neis seria meningitidis was identified as the precipitating pathogen in mos t of the patients. The mean TBSA full-thickness skin loss was 33%. Fou rteen extremities were amputated in the seven patients, including thre e patients with amputations of all four extremities. Transfer to our i nstitution occurred after a mean delay of 20 days, usually after the d emarcation of viable tissue. In one patient, however, fasciotomies obv iated multiple impending amputations. Monitoring for elevated compartm ent pressures, early fasciotomies, and expedient transfer to a burn ce nter for a multidiciplinary approach to care should improve the outcom e in patients with purpura fulminans.