# Purpura Fulminans in an Extremely Premature Infant: A Case Report

## TL;DR

A case report describes purpura fulminans in an extremely premature infant, highlighting the importance of early diagnosis and ethical care.

## Contribution

This case report presents the smallest reported preterm infant with purpura fulminans and emphasizes multidisciplinary treatment and ethical decision-making.

## Key findings

- Purpura fulminans occurred in a 520 g infant born at 24 + 3 weeks gestation.
- Early multidisciplinary treatment improved the patient's condition despite complications like osteomyelitis.
- Genetic testing excluded congenital protein C/S deficiency, pointing to an infectious cause.

## Abstract

What are the main findings?
Purpura fulminans can occur in extremely premature infants, although rarely described.Early recognition and aggressive multidisciplinary treatment are essential for survival.

Purpura fulminans can occur in extremely premature infants, although rarely described.

Early recognition and aggressive multidisciplinary treatment are essential for survival.

What is the implication of the main finding?
Ethical decision-making and family-centered care are key throughout the clinical course.

Ethical decision-making and family-centered care are key throughout the clinical course.

Neonatal purpura fulminans is a rare and challenging diagnosis due to its resemblance to other necrotizing skin conditions and the immature coagulation system in newborns. Early multidisciplinary intervention is key. We present the case of an extremely premature infant, born at 24 + 3 weeks’ gestation and weighing 520 g. Clinical evolution, diagnostic approach, and therapeutic strategies are described. By day 5, the infant developed hemorrhagic-necrotic skin lesions. Diagnosis of purpura fulminans led to broad-spectrum antibiotics, anticoagulation, supportive care, and surgery. Despite complications such as osteomyelitis and scarring, the patient’s condition improved. Genetic testing ruled out congenital protein C/S deficiency, suggesting an infectious etiology. Therapeutic decisions were guided by ethical considerations, prioritizing family-centered care and patient comfort. This case adds to the limited literature on purpura fulminans in preterm infants and, to our knowledge, represents the smallest patient reported to date.