A case of bilateral forearm amputation resulting from purpura fulminans following subtotal colectomy for perforated ulcerative colitis

Abstract

Introduction: Purpura Fulminans (PF) is a complication commonly associated with scarlet fever and meningococcal infection in infants but is also reported in adult patients. Limb ischemia is a devastating complication and amputation may be necessary to reduce mortality. Case report: We report a 49-year-old, previously healthy female patient, who presented with ulcerative colitis and underwent a colonoscopy. Post-operatively, she presented one week later with transverse colon perforation requiring subtotal colectomy, abdominal washout and ileostomy. Her case was further complicated by an intra-abdominal infection causing septic shock. She then developed purpuric skin patches, sparing the trunk, and severe ischemia of her distal extremities consistent with PF. Despite improved respiratory and hemodynamic status, her limb ischemia continued to progress, and she eventually underwent bilateral forearm amputations. Discussion and conclusion: This case presents an opportunity to discuss the importance of supportive care and hematological treatments to reduce the mortality and control the devastating complications of microvascular coagulation and limb ischemia associated with PF. Optimization of microcirculation, steroid treatment, immunomodulation, protein C zymogen, plasma exchange or replacement can potentially mitigate the injury and should be considered to improve outcome.