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Correspondence | Dec 2012

Purpura Fulminans From Meningococcemia Mimicking Stevens-Johnson Syndrome in an Adult Patient Taking Etanercept

Nilanthi D. Gunawardane, MD; Kavita Menon, MD; Joan Guitart, MD; Jonathan A. Cotliar, MD

Arch Dermatol. 2012;148(12):1429-1431. doi:10.1001/2013.jamadermatol.31.

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Purpura fulminans (PF) is a potentially life-threatening condition manifested by cutaneous necrosis and hemorrhage due to dermal vascular thrombosis. Rare in adults, PF occurs in the setting of sepsis and disseminated intravascular coagulation (DIC). We present a case of fatal meningococcal PF mimicking Stevens-Johnson Syndrome (SJS) in an adult patient undergoing treatment with etanercept and prednisone.

Correspondence: Dr Cotliar, Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 1600, Chicago, IL 60611 (j-cotliar@northwestern.edu).

Conflict of Interest Disclosures: None reported.

Funding/Support: Dr Cotliar is supported by a Medical Dermatology Career Development Award from the Dermatology Foundation.

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Figure 1. Skin sloughing and necrosis with minimal purpura mimicking Stevens-Johnson syndrome and/or evolving toxic epidermal necrolysis.

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Figure 2. Epidermal necrosis, dermal vascular thrombosis, and mild perivascular inflammation characteristic of purpura fulminans (hematoxylin-eosin, original magnification ×10).

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Gunawardane ND, Menon K, Guitart J, Cotliar JA. Purpura Fulminans From Meningococcemia Mimicking Stevens-Johnson Syndrome in an Adult Patient Taking Etanercept. Arch Dermatol. 2012;148(12):1429-1431. doi:10.1001/2013.jamadermatol.31.

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