Journal of Child

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Case Report


DOI :10.5222/j.child.2014.156   IUP :10.5222/j.child.2014.156    Full Text (PDF)

Hyperbaric Oxygen Treatment for Purpura Fulminans in a Child with Meningococcemia

Manolya Kara, Murat Sütçü, Ayper Somer, Emel Ekşi Alp, Kübranur Baş, Hacer Aktürk, Nezahat Gürler, Nuran Salman

Meningococcemia may lead to purpura fulminans (PF), multiorgan failure and death unless prompt diagnosis, and treatment can not be achieved. In recent years hyperbaric oxygen treatment has been used. In the management of skin lesions developed secondary to PF. Herein we present a child whose skin lesions developed following onset of PF lesions which were resolved markedly with hyperbaric oxygen (HBO2 ) therapy. Case report: AA 6- month- 20 day- old previously healthy girl presented to our clinic with fever and generalized purpuric rash which developed within hours. On her physical examination, she was conscious but septic and agitated with 38.5 °C fever (tympanic). Glasgow Coma Score was 13. Heart beat, respiratory rate, blood pressure and O2 saturation at room air were noted as following: respectively, 160/min, 42/min, 77/45 mmHg, 96%. Initial blood tests showed anemia with high procalcitonin and C-reactive protein levels. She was started on aggressive hydration and antibiotherapy (ceftriaxone) in pediatric intensive care unit. Vasopressors and hydrocortisone were administered due to hypotension. Supportive transfusions were performed since anemia, thrombocytopenia and hypoalbuminemia had developed. HBO2 treatment was applied to necrotic lesions on her feet. Blood cultures revealed Neisseria meningitidis W 135. Her general condition improved gradually within days and she was discharged from the hospital on 28th day with recovery. A marked improvement was observed in her skin lesions, and her cranial magnetic resonance revealed regression of her bölümeeding episodes. Conclusion: Early diagnosis and appropriate intervention is crucial to decrease mortality and morbidity of fulminant meningococcemia. HBO2 treatment is highly recommended for the management of PF.

Keywords: Meningococcemia, purpura fulminans, hyperbaric oxygen treatment
DOI :10.5222/j.child.2014.156   IUP :10.5222/j.child.2014.156    Full Text (PDF)

Meningokoksemiye Bağlı Purpura Fulminanslı Çocuk Hastada Hiperbarik Oksijen Tedavisi

Manolya Kara, Murat Sütçü, Ayper Somer, Emel Ekşi Alp, Kübranur Baş, Hacer Aktürk, Nezahat Gürler, Nuran Salman

Meningokosemi, hızla tanı konulup tedavi edilmediği takdirde purpura fulminans (PF), çoklu organ yetersizliği ve ölüme neden olmaktadır. PF’a sekonder gelişen cilt lezyonlarının tedavisinde son yıllarda hiperbarik oksijen (HBO2 ) tedavisi başarılı bir biçimde uygulanmaktadır. Bu makalede, PF sonrası gelişen cilt lezyonları HBO2 tedavisi ile belirgin düzelme gözlenen bir hasta sunulmaktadır. Vaka sunumu: Öncesinde sağlıklı 6 ay 20 günlük kız hasta, kliniğimize ateş ve saatler içinde gelişen purpurik döküntü nedeniyle getirildi. Fizik muayenede, bilinci açık ancak ajite ve septik görünümlüydü. Glasgow Koma skoru: 13; KTA, 160/dk; DSS, 42; KB,77/45 mmHg; oda havasında oksijen saturasyonu %96 ve ateşi 38.5°C (timpanik) idi. Laboratuvar incelemesinde anemi, beraberinde prokalsitonin ve CRP yüksekliği mevcuttu. Yoğun bakım ünitesinde izleme alınan hastaya agresif sıvı tedavisi, antibiyoterapi, hipotansif seyretmesi nedeniyle vazopresör desteği ve hidrokortizon uygulandı. Anemi, trombositopeni ve hipoalbuminemi gelişmesi nedeniyle transfüze edildi. Her iki alt ekstremite, ayak sırtında gelişen nekrotik cilt lezyonlarına HBO2 tedavisi uygulandı. Kan kültüründe Neisseria meningitidis W 135 üremesi bildirilen hastanın klinik bulguları giderek düzeldi ve yatışının 28. gününde taburcu edildi. Kraniyal manyetik rezonans görüntülemesinde kanamada regresyon izlenen hastanın cilt bulgularında belirgin iyileşme gözlendi. Sonuç: Fulminan meningokoksemide mortalite ve morbiditeyi azaltmak için erken ve uygun yaklaşım esastır. Purpura fulminans lezyonlarının tedavisinde HBO2 kuvvetle önerilmektedir.

Keywords: Meningokoksemi, purpura fulminans, hiperbarik oksijen tedavisi

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APA

Kara, M., Sütçü, M., Somer, A., Ekşi Alp, E., Baş, K., Aktürk, H., Gürler, N., & Salman, N. (2014). Hyperbaric Oxygen Treatment for Purpura Fulminans in a Child with Meningococcemia. Journal of Child, 14(4), 156-159. https://doi.org/10.5222/j.child.2014.156


AMA

Kara M, Sütçü M, Somer A, Ekşi Alp E, Baş K, Aktürk H, Gürler N, Salman N. Hyperbaric Oxygen Treatment for Purpura Fulminans in a Child with Meningococcemia. Journal of Child. 2014;14(4):156-159. https://doi.org/10.5222/j.child.2014.156


ABNT

Kara, M.; Sütçü, M.; Somer, A.; Ekşi Alp, E.; Baş, K.; Aktürk, H.; Gürler, N.; Salman, N. Hyperbaric Oxygen Treatment for Purpura Fulminans in a Child with Meningococcemia. Journal of Child, [Publisher Location], v. 14, n. 4, p. 156-159, 2014.


Chicago: Author-Date Style

Kara, Manolya, and Murat Sütçü and Ayper Somer and Emel Ekşi Alp and Kübranur Baş and Hacer Aktürk and Nezahat Gürler and Nuran Salman. 2014. “Hyperbaric Oxygen Treatment for Purpura Fulminans in a Child with Meningococcemia.” Journal of Child 14, no. 4: 156-159. https://doi.org/10.5222/j.child.2014.156


Chicago: Humanities Style

Kara, Manolya, and Murat Sütçü and Ayper Somer and Emel Ekşi Alp and Kübranur Baş and Hacer Aktürk and Nezahat Gürler and Nuran Salman. “Hyperbaric Oxygen Treatment for Purpura Fulminans in a Child with Meningococcemia.” Journal of Child 14, no. 4 (Apr. 2025): 156-159. https://doi.org/10.5222/j.child.2014.156


Harvard: Australian Style

Kara, M & Sütçü, M & Somer, A & Ekşi Alp, E & Baş, K & Aktürk, H & Gürler, N & Salman, N 2014, 'Hyperbaric Oxygen Treatment for Purpura Fulminans in a Child with Meningococcemia', Journal of Child, vol. 14, no. 4, pp. 156-159, viewed 29 Apr. 2025, https://doi.org/10.5222/j.child.2014.156


Harvard: Author-Date Style

Kara, M. and Sütçü, M. and Somer, A. and Ekşi Alp, E. and Baş, K. and Aktürk, H. and Gürler, N. and Salman, N. (2014) ‘Hyperbaric Oxygen Treatment for Purpura Fulminans in a Child with Meningococcemia’, Journal of Child, 14(4), pp. 156-159. https://doi.org/10.5222/j.child.2014.156 (29 Apr. 2025).


MLA

Kara, Manolya, and Murat Sütçü and Ayper Somer and Emel Ekşi Alp and Kübranur Baş and Hacer Aktürk and Nezahat Gürler and Nuran Salman. “Hyperbaric Oxygen Treatment for Purpura Fulminans in a Child with Meningococcemia.” Journal of Child, vol. 14, no. 4, 2014, pp. 156-159. [Database Container], https://doi.org/10.5222/j.child.2014.156


Vancouver

Kara M, Sütçü M, Somer A, Ekşi Alp E, Baş K, Aktürk H, Gürler N, Salman N. Hyperbaric Oxygen Treatment for Purpura Fulminans in a Child with Meningococcemia. Journal of Child [Internet]. 29 Apr. 2025 [cited 29 Apr. 2025];14(4):156-159. Available from: https://doi.org/10.5222/j.child.2014.156 doi: 10.5222/j.child.2014.156


ISNAD

Kara, Manolya - Sütçü, Murat - Somer, Ayper - Ekşi Alp, Emel - Baş, Kübranur - Aktürk, Hacer - Gürler, Nezahat - Salman, Nuran. “Hyperbaric Oxygen Treatment for Purpura Fulminans in a Child with Meningococcemia”. Journal of Child 14/4 (Apr. 2025): 156-159. https://doi.org/10.5222/j.child.2014.156



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