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Journal of Case Reports
Purpura Fulminans with Peripheral Gangrene in Severe Falciparum Malaria: A Case Series
A Fowotade1, RE Oladokun2, OE Bello2 , EO Aigbovo1
1Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria. 2Department of Paediatrics, College of Medicine, University of Ibadan, Nigeria.
Corresponding Author:
Dr. Adeola Fowotade
Email: temilabike@gmail.com
Received: 30-NOV-2017 Accepted: 18-DEC-2017 Published Online: 30-JAN-2018
DOI: http://dx.doi.org/10.17659/01.2018.0008
Background: Purpura fulminans is an acute fatal illness consisting of septicaemia, shock, and disseminated intravascular coagulation, often manifesting with gangrene of the distal extremities and necrosis of skin. Purpura fulminans associated with severe malaria has rarely been reported among children. Case Report: Two cases of purpura fulminans with disseminated intravascular coagulation probably due to severe falciparum malaria, are presented from a tertiary health facility in Nigeria.  Both cases were males, and were infants aged 6 and 7 months respectively. They presented with fever, seizures, loss of consciousness and features of shock and had associated peripheral gangrene which developed hours into admission. Investigations showed P. falciparum hyper-parasitemia and evidence of disseminated intravascular coagulation.  No focus for sepsis was identified and there were no bacterial isolates from blood culture. The second child survived but was left with amputated digits and audiovisual deficits. Conclusion:  The cases presented demonstrate that purpura fulminans can occur in children with severe malaria even in P. falciparum endemic settings.
Keywords : Child, Falciparum Malaria, Gangrene, Necrosis, Purpura Fulminans.
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