Case 2: Is It Neonatal Purpura Fulminans?

Case 1

A term newborn is first examined immediately after birth because of a widespread skin lesion that looks like cavernous hemangioma on his trunk and limbs (Fig 1). He had been born in a spontaneous vaginal delivery at the 40^th week of gestation, with a birthweight of 3,450 g and an Apgar score of 9 and 10 at 1 and 5 minutes, respectively. The mother is a gravida 6, para 2, and abortus 3. Because she has had 3 spontaneous abortions, she undergoes a hypercoagulability profile whose findings are normal. The infant has a complete blood cell count that is normal, and shows no evidence of thrombocytopenia. The cutaneous lesions on his limbs, left palm, left knee, and right ankle are observed to be worsening at the age of 28 hours, and the skin looks like purpura with the beginning of necrosis (Fig 2). At this point, the blood tests show an elevation in the international normalized ratio (INR; 2.65) and a decrease in fibrinogen (110.7 mg/dL [3.25 μmol/L]), and he receives fresh frozen plasma (FFP). He is transferred to the hematology department in a tertiary hospital to monitor his clotting factors. The differential diagnosis …