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Purpura fulminans consists of skin necrosis caused by thrombosis of the dermal vessels in the setting of disseminated intravascular coagulation (DIC). The most common cause of this syndrome is infection with Neisseria meningitidis, but association with numerous other organisms has also been recorded. The risk for purpura fulminans is higher in patients with an absent spleen or decreased splenic function. These authors describe 5 cases of purpura fulminans in asplenic or hyposplenic adults seen in a New York City hospital, 4 caused by Streptococcus pneumoniae and 1 by S. pyogenes.
As in previously reported cases, the skin lesions in these patients began as erythematous or purpuric macules that progressed to skin necrosis and gangrene over 24 …