Long-term management of homozygous protein C deficiency: Replacement therapy with subcutaneous purified protein C concentrate

We present the case of a full-term newborn in whom purpura fulminans develo ped shortly after birth. A diagnosis of homozygous protein C deficiency was established based upon undetectable plasma protein C activity and antigene mia in the newborn infant, and was later confirmed by protein C gene analys is. Specific replacement therapy with intravenous protein C concentrate was started 9 days after birth. This rapidly led to the complete regression of cutaneous lesions and consumption coagulopathy. After stabilization, oral anticoagulation was initiated in association with prophylactic treatment wi th intravenous protein C concentrate. However, oral anticoagulation was fin ally abandoned as the patient presented several thrombotic and hemorrhagic episodes clearly related to difficulties with anticoagulation. Due to the h azards related to prolonged venous access, we are currently using subcutane ous infusion of protein C concentrate for the long term management of this condition, with satisfactory results.