Postinfectious Intravascular Thrombosis With Gangrene

POSTINFECTIOUS intravascular thrombosis with gangrene is a term applied by Little 1 to an unusual and perplexing vascular syndrome usually seen in children following an infectious illness. Purpura fulminans, purpura hemorrhagica, and purpura gangrenosa have also been applied to the same condition. 2-7 The condition is characterized by the development of marbled areas of cyanosis and pallor usually of the buttocks, lower extremities, and lower abdominal wall. The cyanotic areas rapidly become hemorrhagic and gangrene of a greater or lesser degree frequently develops. Other soft tissue areas may be involved and points of pressure and minor trauma seem predisposed. 1,2,5 Although skin and soft tissue involvement predominates, involvement of the gut, kidneys, and spinal cord have been described. 1-4,8,9 An allergic vasculitis is believed to be the principal mechanism involved. Thrombocytopenia, hypoprothrombinemia, and hypofibrinogenemia may result from extensive intravascular thromboses. 1,4,7,9 More recently, accidental intra-arterial injection of penicillin has been incriminated