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Chirurgia 2018 February;31(1):30-6

DOI: 10.23736/S0394-9508.17.04705-2

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Purpura fulminans in a 16-year-old girl: clinical and ethical aspects

Serena SAVAIA 1 , Simonetta FRANCHELLI 1, Sara PATUZZO 2, Stefano BIGGI 3, Marianna PESCE 1, Rosella CILIBERTI 4, Ilaria BALDELLI 1, 5

1 Unit of Plastic and Reconstructive Surgery, San Martino Institute for Research and Care, Genoa, Italy; 2 Faculty of Medicine and Surgery, University of Verona, Verona, Italy; 3 Ortopedics and Traumatology Clinic, San Martino Institute for Research and Care, Genoa, Italy; 4 Bioethics Division, Department of Legal Medicine, Psychology and Criminology, University of Genoa, Genoa, Italy; 5 Department of Surgery and Integrated Diagnostics, University of Genoa, Genoa, Italy


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Purpura fulminans (PF) is a severe clinical disorder mostly characterized by progressive vascular collapse and disseminated intravascular coagulopathy (DIC). The most frequent presentation is following meningococcal infection. PF leads to serious complications including multiple organ failure (MOF) until death in 3-12% of cases. However, a number of disabilities have been reported. We report a case of a young girl with septic shock, high fever, purple rash on the legs and buttocks. Clinical and laboratory tests confirmed N. meningitidis infection. Medical treatment included antibiotics and pain killers. Surgical treatments included multiple escharectomies, skin grafts and the amputation of the distal phalanx of the right foot. Psychological support was guaranteed. After 75 days of hospital stay, the patient was discharged with an acceptable aesthetic and functional result. The possibility to conduct extensive surgical treatments, although life-saving, constituted a decision of strong ethical criticality, but in this case the patient has understood the importance of the proposed treatments. PF represents a challenging issue in clinical practice, both for the medical assessment, both for the surgical treatment. Younger patients require more care for the acceptance and sharing of the therapeutic process. Even the cases earlier treated may have residual disabilities. A multidisciplinary team can optimize and improve the quality of life of minors. Psychological support and a very intensive rehabilitation are necessary for the integration back into society. Good communication between healthcare professionals and young people is essential.


KEY WORDS: Purpura fulminans - Amputation - Neisseria meningitidis - Bioethics - Infection

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