Hyperbaric oxygen: A useful adjunct for purpura fulminans Case report and review of the literature

Introduction: We report a case of a previously healthy adult with flulike symptoms who precipitously declined due to pneumococcal sepsis complicated by disseminated intravascular coagulation (DIC) and purpura fulminans (PF). After one week of care, including ventilation support and hemodialysis, the patient was stable enough for hyperbaric oxygen (HBO₂) in an attempt to salvage his threatened extremities. HBO₂ resulted in reduction of ischemic tissue and demarcation of blackened tissue to the distal digits. We feel that much at-risk tissue has been spared by HBO₂ as an adjunctive therapy. Methods: Literature on the use of hyperbaric oxygen for purpura fulminans was reviewed for precipitating issues, time to treatment, protocol, other adjuncts and outcomes. Results: Fifteen papers were identified representing 19 cases of PF treated with HBO₂. No controlled studies exist. HBO₂ was believed to be of value in most cases; the improvement was associated with timeliness and aggressiveness of initiating HBO₂. Conclusions: PF is a fulminant disorder with high mortality and morbidity. Hyperbaric oxygen appears to be useful for the management of PF complications, imposing minimal side effects or complications. Aggressive therapy should be started as soon as it is safe to transfer the patient to a facility for HBO₂ treatments.