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- Title
BEYOND THE SURFACE: UNVEILING THE CHALLENGES OF SEVERE PNEUMONIA AND FULMINANT PURPURA IN ADOLESCENCE.
- Authors
Rusu, Elena-Camelia; Grama, Alina
- Abstract
Introduction: Purpura fulminans (PF) is a severe and potentially life-threatening condition characterized by the sudden onset of skin hemorrhage and tissue necrosis, often accompanied by intravascular coagulation. Case Report: This case report presents a 15-year-old male from a rural area admitted to Târgu Mureş Emergency Hospital with symptoms of dry cough, high fever, and headache. Despite initial treatment with antibiotics and antipyretics at home, his symptoms persisted, leading to hospitalization. Upon admission, the patient presented with dry cough, normal chest configuration, decreased breath sounds in the right basal lung, and crepitant rales. Laboratory investigations revealed elevated levels of C-reactive protein (CRP) and a chest X-ray showed small opacities in the right infrahilar region suggestive of a developing consolidation focus. Based on clinical and laboratory findings, a presumptive diagnosis of right basal pneumonia was made, and treatment was initiated with iv antibiotics and symptomatic therapy. Over the following days, the patient's condition deteriorated. Blood cultures were negative, but the antibiotic was switched to a broad-spectrum antibiotic. Afterward, the patient experienced a semi-productive cough, vomiting, and a purpuric rash. It started from the lower limb, then progressed to the trunk, followed by the upper limb, and finally reached the oral cavity. Discussions : Differential diagnoses considered at this stage included acute infectious purpura fulminans, Kawasaki disease, and meningococcemia. Antibiotic treatment was halted, and further investigations, including lumbar puncture and consultations with infectious disease, cardiology, and ophthalmology specialists, were initiated. Meningitis was ruled out, and no significant abnormalities were found in cardiological and ophthalmological evaluations. Conclusions: The final diagnoses included right lower lobe pneumonia, systemic inflammatory response syndrome, and acute infectious purpura fulminans. The patient's condition improved gradually with treatment consisting of broad-spectrum antibiotics, antiinflammatory medication, antiemetic, alongside supportive therapy involving rebalancing treatment with glucose and Ringer's solution. This led to the resolution of fever and purpuric lesions, as well as an improvement in respiratory symptoms. This case underscores the critical importance of accurate diagnosis and prompt initiation of appropriate antibiotic therapy.
- Subjects
ROMANIA; PNEUMONIA; SCHOENLEIN-Henoch purpura; SEVERITY of illness index; PATIENT care; CONFERENCES &; conventions; SYMPTOMS
- Publication
Acta Marisiensis. Seria Medica, 2024, Vol 70, p285
- ISSN
2668-7755
- Publication type
Article