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Four-extremity amputation following disseminated intravascular coagulation and purpura fulminans
  1. Umar F Bhatti,
  2. Aaron M Williams,
  3. Krishnan Raghavendran and
  4. Patrick E Georgoff
  1. Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Umar F Bhatti, ufb{at}


Purpura fulminans (PF) is a rare but serious complication of septic shock in adults. The complex disease course makes it challenging to manage the condition. Here, we present the case of a healthy young woman who presented with sepsis and new-onset erythematous lesions 4 days after the vaginal delivery of a healthy baby. The infectious source could not be identified, and the patient was started on antibiotics and resuscitated. However, her condition worsened, and she developed disseminated intravascular coagulation and PF. The septic episode slowly decreased in severity, but she sustained extensive ischaemic injuries to her extremities, for which she underwent four-limb amputation.

  • surgery
  • dermatology
  • obstetrics, gynaecology and fertility
  • purpura fulminans

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  • Contributors UFB, AMW and PEG: participated in the conception and drafting of the manuscript. KR, AMW and PEG: directly involved in taking care of the patient. All authors performed the critical revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.