{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:17:07Z","timestamp":1782908227949,"version":"3.54.5"},"reference-count":13,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T00:00:00Z","timestamp":1763164800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Neonatal purpura fulminans is a rare and challenging diagnosis due to its resemblance to other necrotizing skin conditions and the immature coagulation system in newborns. Early multidisciplinary intervention is key. We present the case of an extremely premature infant, born at 24 + 3 weeks\u2019 gestation and weighing 520 g. Clinical evolution, diagnostic approach, and therapeutic strategies are described. By day 5, the infant developed hemorrhagic-necrotic skin lesions. Diagnosis of purpura fulminans led to broad-spectrum antibiotics, anticoagulation, supportive care, and surgery. Despite complications such as osteomyelitis and scarring, the patient\u2019s condition improved. Genetic testing ruled out congenital protein C\/S deficiency, suggesting an infectious etiology. Therapeutic decisions were guided by ethical considerations, prioritizing family-centered care and patient comfort. This case adds to the limited literature on purpura fulminans in preterm infants and, to our knowledge, represents the smallest patient reported to date.<\/jats:p>","DOI":"10.3390\/children12111546","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T14:04:07Z","timestamp":1763388247000},"page":"1546","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Purpura Fulminans in an Extremely Premature Infant: A Case Report"],"prefix":"10.3390","volume":"12","author":[{"given":"Anna Rojas","family":"Roig","sequence":"first","affiliation":[{"name":"Neonatology Department, BCNatal\u2014Centre de Medicina Maternofetal i Neonatologia de Barcelona, Hospital Cl\u00ednic, Universitat de Barcelona, 08028 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo Costa F\u00e9lix","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Neonatology Department, BCNatal\u2014Centre de Medicina Maternofetal i Neonatologia de Barcelona, Hospital Cl\u00ednic, Universitat de Barcelona, 08028 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3943-7317","authenticated-orcid":false,"given":"Cristina","family":"Borr\u00e0s-Novell","sequence":"additional","affiliation":[{"name":"Neonatology Department, BCNatal\u2014Centre de Medicina Maternofetal i Neonatologia de Barcelona, Hospital Cl\u00ednic, Universitat de Barcelona, 08028 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna \u00c1lvarez","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Neonatology Department, BCNatal\u2014Centre de Medicina Maternofetal i Neonatologia de Barcelona, Hospital Sant Joan de D\u00e9u, Universitat de Barcelona, 08950 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Espinosa","family":"Gimenez","sequence":"additional","affiliation":[{"name":"Neonatology Department, BCNatal\u2014Centre de Medicina Maternofetal i Neonatologia de Barcelona, Hospital Sant Joan de D\u00e9u, Universitat de Barcelona, 08950 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel Bejarano","family":"Serrano","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Hospital Sant Joan de D\u00e9u, Universitat de Barcelona, 08950 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma P\u00e9rez","family":"Acevedo","sequence":"additional","affiliation":[{"name":"Pediatric Nurse, Hospital Sant Joan de D\u00e9u, Universitat de Barcelona, 08950 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Gracia","sequence":"additional","affiliation":[{"name":"Neonatology Department, BCNatal\u2014Centre de Medicina Maternofetal i Neonatologia de Barcelona, Hospital Cl\u00ednic, Universitat de Barcelona, 08028 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c0frica Pertierra","family":"Cortada","sequence":"additional","affiliation":[{"name":"Neonatology Department, BCNatal\u2014Centre de Medicina Maternofetal i Neonatologia de Barcelona, Hospital Sant Joan de D\u00e9u, Universitat de Barcelona, 08950 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0139-7279","authenticated-orcid":false,"given":"Miguel Alsina","family":"Casanova","sequence":"additional","affiliation":[{"name":"Neonatology Department, BCNatal\u2014Centre de Medicina Maternofetal i Neonatologia de Barcelona, Hospital Cl\u00ednic, Universitat de Barcelona, 08028 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1111\/j.1442-200X.2006.02219.x","article-title":"Purpura fulminans due to Stenotrophomonas maltophilia infection in a premature infant","volume":"48","author":"Aygun","year":"2006","journal-title":"Pediatr. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.1055\/s-0034-1376186","article-title":"Purpura fulminans and late onset group B streptococcal sepsis in a premature twin","volume":"4","author":"Elayappen","year":"2014","journal-title":"AJP Rep."},{"key":"ref_3","first-page":"463","article-title":"Neonatal Purpura Fulminans, a rare genetic disorder due to protein C deficiency: A case report","volume":"68","author":"Kazi","year":"2018","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.thromres.2021.12.026","article-title":"Clinical and genetic features of Chinese pediatric patients with severe congenital protein C deficiency who first presented with purpura fulminans: A case series study and literature review","volume":"210","author":"Tang","year":"2022","journal-title":"Thromb. 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[3rd ed.]."},{"key":"ref_12","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":"ref_13","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1097\/MBC.0000000000000687","article-title":"A novel compound heterozygous mutations in protein C gene causing neonatal purpura fulminans","volume":"29","author":"Zhang","year":"2018","journal-title":"Blood Coagul. Fibrinolysis"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/11\/1546\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T14:42:54Z","timestamp":1763390574000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/11\/1546"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,15]]},"references-count":13,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["children12111546"],"URL":"https:\/\/doi.org\/10.3390\/children12111546","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,15]]}}}