A case of neonatal purpura fulminans successfully treated, saving life and limb

Abstract

Neonatal purpura fulminans is a rare but life-threatening condition characterized by microvascular thrombosis, disseminated intravascular coagulation, and rapid progression to skin necrosis and multiorgan dysfunction. We report the case of a term Sri Lankan neonate who presented within hours of birth with bilateral lower-limb discoloration and evolving gangrene. Prompt recognition and immediate initiation of treatment—comprising fresh frozen plasma, platelet-rich plasma, anticoagulation with heparin and enoxaparin, vitamin K, and broad-spectrum antibiotics—resulted in complete recovery without the need for surgical amputation. Protein C and S levels were normal after transfusions, and no inherited deficiency was confirmed. Despite severe clinical deterioration, including circulatory failure and seizures on day five, the infant responded to escalated supportive care and showed progressive tissue healing. This case highlights the critical importance of early diagnosis, aggressive supportive therapy, and sustained monitoring in managing neonatal purpura fulminans, especially in low-resource settings where protein C concentrates may be unavailable. Effective treatment can be achieved using available modalities, preventing mortality and preserving limb function.