Purpura fulminans.

Five recent cases of purpura fulminans associated with Staphylococcus aureus strains that produce high levels of superantigens suggest that this is a newly emerging clinical entity, Gary R. Kravitz, M.D., an infectious disease specialist in group practice in St. Paul, Minn., and his colleagues reported.

These patients represent the first known cases of purpura fulminans directly associated with S. aureus strains that produce high levels of toxic shock syndrome toxin-1, S. enterotoxin serotype B, or S. enterotoxin serotype C. One patient had a methicillin-resistant strain, and only two of the five patients survived, the investigators reported (Clin, Infect. Dis. 2005;40:941-4).

The clinical presentations were identical to those for patients with fulminant meningococcemia, which is much more common. Patients presenting with purpura fulminans should receive antibiotic therapy active against Neisseria meningitidis and streptococci, as well as methicillin-resistant S. aureus, the investigators advised.

Early administration of activated protein C to minimize purpuric skin injury may be indicated, as well as intravenous immunoglobulin therapy (which contains significant antibodies against the causative exotoxins), they noted.