Purpura fulminans during meningococcal sepsis treated with Drotrecogin alpha. A clinical case.

A male patient, 29 years old, was admitted to our unit with purpura fulminans, coagulation deficiency, renal failure and subsequent septic shock accompanied by respiratory insufficiency in the absence of meningeal signs. The serum levels of endogenous protein C, ATIII and calcium were well below the norm. The bacteriological examination revealed the presence of gram-negative diplococci. The onset of adult respiratory distress syndrome (ARDS) revealed aa early complication of the meningococcal sepsis. Forty-eight hours after being admitted, the recombinant protein C infusion was started at a dose of 24 microg/kg/h for the duration of 96 h. The skin lesions regressed, starting from the ecchymosis and the edema of the face, trunk and auricular pavilions. A week after the onset of the symptomatology the chest X-ray appeared clear, the renal function had normalised, and the signs of shock had disappeared.

[Total parenteral nutrition. Analysis of the results of 144 treated cases]. / Nutrizione parenterale totale. Analisi dei risultati su 144 casi trattati.

Of 144 patients treated with T.P.N. in the period 1-5-1987/30-9-1988, 128 have been to have an operation. Their survival at the time of the removal, the post-operating mortality, the average stay in hospital, have been compared with those of other 128 patients non-treated with T.P.N., suffering from similar pathologies and who had operation of the same kind. The obtained results have stressed in the patients treated with T.P.N. as in those who had not, a survival at the time of the removal of 75% contrary to 62.5%, a post-operating mortality of 25% contrary to 37.5%, an average post-operative stay in hospital of 13 days contrary to 15 days. The statistical elaboration executed with chi 2's test with Yates' correction, provided 0.25 less than P greater than 0.50, so data non particularly meaningful. In our casuistry the percentage of surviving in the patients treated with T.P.N. as to those not treated, is nevertheless, very encouraging; furthermore, we most think that only by taking advantage of T.P.N. has been possible to extend the operability to patients that in the past because of well on years, or because of dangerous surgical illnesses joined to dismetabolic and cardiovascular diseases, were judged not operable.