A Case of Acute Infectious Purpura Fulminans following Laparoscopic Cholecystectomy

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  • FUJITA Haruku
    Departments of Surgery, Gastroenterological Surgery and Breast Surgery, Otsu City Hospital
  • OHE Hidenori
    Departments of Surgery, Gastroenterological Surgery and Breast Surgery, Otsu City Hospital
  • UEMURA Taisuke
    Departments of Surgery, Gastroenterological Surgery and Breast Surgery, Otsu City Hospital
  • HIRAI Kenjiro
    Departments of Surgery, Gastroenterological Surgery and Breast Surgery, Otsu City Hospital
  • TACHIBANA Tsuyoshi
    Departments of Surgery, Gastroenterological Surgery and Breast Surgery, Otsu City Hospital
  • MITSUYOSHI Akira
    Departments of Surgery, Gastroenterological Surgery and Breast Surgery, Otsu City Hospital

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Other Title
  • 腹腔鏡下胆嚢摘出術後に発症した急性感染性電撃性紫斑病の1例
  • 腹腔鏡下胆囊摘出術後に発症した急性感染性電撃性紫斑病の1例
  • フククウキョウ カ タンノウ テキシュツ ジュツゴ ニ ハッショウ シタ キュウセイ カンセンセイ デンゲキセイ シハンビョウ ノ 1レイ

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Abstract

<p>A 53-year-old man presented with a chief complaint of upper abdominal pain. Cholangitis or cholecystitis was diagnosed, and endoscopic papillotomy was performed, followed by laparoscopic cholecystectomy. From postoperative Day 10, he developed fever and septic shock, and on Day 13, widespread, irregularly shaped purpura appeared rapidly on the legs and trunk, leading to a diagnosis of acute infectious purpura fulminans. He was brought through the acute phase with antibiotic administration, anticoagulant therapy, artificial ventilation, and dialysis. However, an ulcer developed over the right peroneus longus muscle, and debridement was performed. The patient's general condition improved with multimodal treatment, and he was transferred to another hospital on postoperative Day 136. Acute infectious purpura fulminans is a syndrome in which an infection causes rapidly progressing ischemic necrosis, predominantly in the distal extremities, shock, and disseminated intravascular coagulation. It has a poor prognosis, with a mortality rate exceeding 30%, and since there is no established method of treatment, it is vital to start appropriate treatment at an early stage and endeavor to maintain the peripheral circulation. No previous case of purpura fulminans following laparoscopic cholecystectomy has been reported either in Japan or elsewhere.</p>

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