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

대한마취과학회지 2021년 74권 3호 p.266 ~ 270
Viderman Dmitriy, Umbetzhanov Yerlan, Temirov Talgat, Kuzkov Vsevolod V.,
소속 상세정보
 ( Viderman Dmitriy ) - Nazarbayev University School of Medicine Department of Biomedical Sciences
 ( Umbetzhanov Yerlan ) - National Research Oncology Center Department of Anesthesiology and Critical Care
 ( Temirov Talgat ) - National Research Oncology Center Department of Anesthesiology and Critical Care
 ( Kuzkov Vsevolod V. ) - Northern State Medical University Department of Anesthesiology and Intensive Care Medicine

Abstract


Background: Pregnancy-related infections are the third most common cause of maternal death worldwide. The 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.

키워드

Disseminated intravascular coagulation; Hypercoagulability; Purpura fulminans; Sepsis; Septic shock; Therapeutic use; Vasoconstrictor agents.

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