The role of heparin in treatment of purpura fulminans: Experience in four cases

Purpura fulminans, most commonly seen in previously healthy children associated with meningococcal sepsis and meningitis, is a rare catastrophic disease with initial hemorrhagic skin lesions rapidly progressing to gangrene accompanied by shock and frequently resulting in death. We encountered patients with purpura fulminans since 1996; three of whose blood culture yielded Neisseria meningitidis. The first two patients died within 48 hours of admission despite aggressive therapy. The latter two patients received treatment of unfractionated intravenous heparin (10-15 IU/kg/h), in addition to antibiotics, and blood product replacement. Both survived with minimal cutaneous sequelae. We deem that with early recognition of this disease and prompt administration of heparin with proper treatment in these patients, a full recovery may be expected.