Refractory gram-negative septic shock complicated by extended purpura fulminans and multiple organ failure in a 23-year-old puerpera -a case report-

다국어 초록 (Multilingual Abstract)

Background: Pregnancy-related infections are the third most common cause of maternal death worldwideThe aim of this report is to present a case of pregnancy-related infection, which progressed into refractory septic shock accompanied by purpura fulminans and multiple organ failure.Case: A 23-year-old woman in the postpartum period developed fulminant, refractory septic shock complicated by purpura fulminans and multiple organ failure syndrome (acute respiratory distress syndrome, acute kidney injury, and encephalopathy). Management included antibacterial therapy, fluid and transfusion therapy, nutritional support, protective mechanical ventilation, hydrocortisone, a large dose of ascorbic acid, and thiamine. There were no neurological consequences and all organ functions returned to normal, although the predicted hospital mortality based on the Sequential Organ Failure Assessment (SOFA) score was more than 90%. Conclusions: Septic shock is a significant, yet not completely understood life-threatening condition, which can be associated with purpura fulminans, multiple organ dysfunction, disseminated intravascular coagulation, and massive tissue necrosis.

참고문헌 (Reference)

1 Khan KS, "WHO analysis of causes of maternal death : a systematic review" 367 : 1066-1074, 2006

2 Bassi E, "Therapeutic strategies for highdose vasopressor-dependent shock" 2013 : 654708-, 2013

3 Martin GS, "The epidemiology of sepsis in the United States from 1979 through 2000" 348 : 1546-1554, 2003

4 Brown SM, "Survival after shock requiring high-dose vasopressor therapy" 143 : 664-671, 2013

5 Parrillo JE, "Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy" 113 : 227-242, 1990

6 Cordioli RL, "Sepsis and pregnancy : do we know how to treat this situation" 25 : 334-344, 2013

7 Cordioli RL, "Sepsis and pregnancy : do we know how to treat this situation" 25 : 334-344, 2013

8 Betrosian AP, "Purpura fulminans in sepsis" 332 : 339-345, 2006

9 Adcock DM, "Proposed classification and pathologic mechanisms of purpura fulminans and skin necrosis" 16 : 333-340, 1990

10 Marlar RA, "Neonatal purpura fulminans due to homozygous protein C or protein S deficiencies" 16 : 299-309, 1990

11 Say L, "Global causes of maternal death : a WHO systematic analysis" 2 : e323-e333, 2014

12 Warner PM, "Current management of purpura fulminans : a multicenter study" 24 : 119-126, 2003

13 Rietschel ET, "Bacterial endotoxin : molecular relationships of structure to activity and function" 8 : 217-225, 1994