Neonatal Purpura Fulminans with Pos Complicated by Hemophagocytic Lymphohistiocytosis: A Rare Presentation of Herpes Simplex Virus Infection

Abstract

Purpura Fulminans is a rare dermatological emergency characterized by purpuric lesions and skin necrosis, often as a result of disruptions in skin vasculature. Three forms of Purpura Fulminans exist: neonatal, idiopathic, and acute infectious, each with distinct characteristics and etiologies. We present a case of a 3-day-old female who was originally admitted to the neonatal intensive care unit (NICU) for respiratory failure, severe metabolic acidosis, and hypercarbia. On day 2, the patient was preparing for discharge, but developed tachypnea and perioral cyanosis. The sudden onset of Purpura Fulminans with cutaneous blisters and fever, lacked conventional triggers, posing diagnostic challenges. The infant’s maternal history involved chlamydia infection during pregnancy. The absence of typical triggers such as Group B Streptococcus or Acinetobacter baumanni, along with a unique presentation of metabolic acidosis and hypercarbia, underscores the complex etiology of this case’s Purpura Fulminans.While the association between Purpura Fulminans and Protein C deficiency is well documented in the literature, the exploration of diverse triggers and clinical presentations demands ongoing research.