Ulcerative colitis presenting as purpura fulminans

A 60-year-old man presented with purpura fulminans involving his chest and flank. He was subsequently found to have active ulcerative colitis (UC) and protein S deficiency. He was treated with heparin and plasma, but because of persistent colitis and progressively worsening purpura, a total colectom y was performed on hospital day 17. This report describes an interesting ca se of purpura fulminans associated with the hypercoagulable state of active UC that responded dramatically to colectomy.