Dados do Trabalho

Título

Purpura Fulminans Complicated with Infectious Endocarditis

Descrição do caso

A fourteen year old female presented to the emergency department with a history of 6 hours evolution of confusion, fever and petechiae in the chest. On past medical records, was informed by relatives a history of pneumonia in November 2022. On arrival, there was worsening of consciousness level, and arterial hypotension. The patient was intubated and received hemodynamic support, with fluids and vasopressor, besides empiric treatment for meningitis with Ceftriaxone and Vancomycin.
The lesions in the chest progressed for purpuric rash, more prominent on extremities, compatible with Purpura Fulminans, and the patient was then transferred to the Intensive Care Unit. On arrival in the ICU, there was a high dose vasopressor dependence, and was noted pulseless and pallor of the left leg - she had an arterial line on femoral artery. Vascular consultant was called and immediate supracondylar amputation was performed. During stabilization, Point-Of-Care Ultrasound was performed, and noted a 2.1 cm mass on the tricuspid valve, and a severe regurgitation associated. Gram analysis identified gram negative diplococcus, but culture was negative. A blood PCR assay for Neisseria meningitidis was done, and the result was positive.
After discussion with multidisciplinary specialists (cardiologists, hematologists and vascular surgeons), it was proposed a period of anticoagulation and antibiotic treatment (Ceftriaxone) and image follow-up of tricuspid mass, based on physiologic mechanisms of hypercoagulation from Purpura Fulminans. After three weeks of treatment, there is reduction in size mass, the patient is well clinically and remains on conservative strategy.