{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T15:47:47Z","timestamp":1762876067473,"version":"3.44.0"},"reference-count":20,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,2,28]]},"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:p>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\u2009days 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.<\/jats:p>","DOI":"10.1136\/bcr-2018-228028","type":"journal-article","created":{"date-parts":[[2019,3,21]],"date-time":"2019-03-21T05:18:08Z","timestamp":1553145488000},"page":"e228028","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Four-extremity amputation following disseminated intravascular coagulation and purpura fulminans"],"prefix":"10.1136","volume":"12","author":[{"given":"Umar F","family":"Bhatti","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron M","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krishnan","family":"Raghavendran","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick E","family":"Georgoff","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,3,20]]},"reference":[{"key":"2025082708502210000_12.3.e228028.1","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1055\/s-2007-1002681","article-title":"Dermatopathology of skin necrosis associated with purpura fulminans","volume":"16","author":"Adcock","year":"1990","journal-title":"Semin Thromb Hemost"},{"key":"2025082708502210000_12.3.e228028.2","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2010.199919"},{"key":"2025082708502210000_12.3.e228028.3","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1055\/s-2007-1002684","article-title":"Acquired purpura fulminans","volume":"16","author":"Francis","year":"1990","journal-title":"Semin Thromb Hemost"},{"key":"2025082708502210000_12.3.e228028.4","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201302-0228OC"},{"key":"2025082708502210000_12.3.e228028.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2007.07.039"},{"key":"2025082708502210000_12.3.e228028.6","doi-asserted-by":"publisher","DOI":"10.1186\/cc3538"},{"key":"2025082708502210000_12.3.e228028.7","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2007.131862"},{"issue":"Suppl 1","key":"2025082708502210000_12.3.e228028.8","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1186\/1471-2105-8-S1-S11","article-title":"ProCMD: a database and 3D web resource for protein C mutants","volume":"8","author":"D\u2019Ursi","year":"2007","journal-title":"BMC Bioinformatics"},{"key":"2025082708502210000_12.3.e228028.9","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1055\/s-0037-1615899","article-title":"Disseminated intravascular coagulation","volume":"82","author":"Levi","year":"1999","journal-title":"Thromb Haemost"},{"key":"2025082708502210000_12.3.e228028.10","doi-asserted-by":"publisher","DOI":"10.1007\/BF01699858"},{"key":"2025082708502210000_12.3.e228028.11","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1186\/s12879-017-2481-y","article-title":"A case report of septic shock syndrome caused by S. pneumoniae in an immunocompromised patient despite of vaccination","volume":"17","author":"Singer","year":"2017","journal-title":"BMC Infect Dis"},{"key":"2025082708502210000_12.3.e228028.12","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1186\/s13104-018-3346-1","article-title":"Gonococcal sepsis in a 32-year-old female: a case report","volume":"11","author":"Owusu","year":"2018","journal-title":"BMC Res Notes"},{"key":"2025082708502210000_12.3.e228028.13","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.cca.2016.07.002","article-title":"Diagnosing sepsis - The role of laboratory medicine","volume":"460","author":"Fan","year":"2016","journal-title":"Clin Chim Acta"},{"key":"2025082708502210000_12.3.e228028.14","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1111\/bjh.12640","article-title":"Subcutaneous protein C concentrate in the management of severe protein C deficiency\u2013experience from 12 centres","volume":"164","author":"Minford","year":"2014","journal-title":"Br J Haematol"},{"key":"2025082708502210000_12.3.e228028.15","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1055\/s-2007-1002686","article-title":"Proposed classification and pathologic mechanisms of purpura fulminans and skin necrosis","volume":"16","author":"Adcock","year":"1990","journal-title":"Semin Thromb Hemost"},{"key":"2025082708502210000_12.3.e228028.16","first-page":"ftx027","article-title":"Pathogenesis of meningococcal purpura fulminans","volume":"75","author":"L\u00e9cuyer","year":"2017","journal-title":"Pathog Dis"},{"key":"2025082708502210000_12.3.e228028.17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200108093450603"},{"key":"2025082708502210000_12.3.e228028.18","doi-asserted-by":"crossref","first-page":"3606","DOI":"10.1182\/blood.V122.21.3606.3606","article-title":"Treatment Of Infection-Associated Purpura Fulminans With Protein C Zymogen Is Associated With a High Survival Rate","volume":"122","author":"Schellongowski","year":"2013","journal-title":"Blood"},{"key":"2025082708502210000_12.3.e228028.19","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s11239-017-1606-x","article-title":"Homozygous protein C deficiency presenting as neonatal purpura fulminans: management with fresh frozen plasma, low molecular weight heparin and protein C concentrate","volume":"45","author":"Kizilocak","year":"2018","journal-title":"J Thromb Thrombolysis"},{"key":"2025082708502210000_12.3.e228028.20","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1202290"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-228028","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:50:29Z","timestamp":1756309829000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-228028"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3]]},"references-count":20,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,3,20]]},"published-print":{"date-parts":[[2019,3]]}},"alternative-id":["10.1136\/bcr-2018-228028"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-228028","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,3]]}}}