To the Editor.—
I found the report by Auletta and Headington1 on the relation between purpura fulminans and congenital or acquired severe protein C deficiency most illuminating in a realm that had been murky before.Several additional questions arise. First, what are the histopathologic findings of the early blanchable lesions, or of those skin lesions that resolve spontaneously, quickly, and without scarring? It would be hard to invoke significant red blood cell extravasation with these features. Could there be a reactive dilatation of thrombus-free or at least unoccluded cutaneous arterioles and venules near those filled with fibrin thrombi? Is there significant cutaneous edema, perhaps from the same mechanism, in watershed zones that do not ultimately suffer intracutaneous and subcutaneous hemorrhage and cutaneous necrosis? Have biopsies ever been performed on early or nonprogressive lesions, either in human patients or in an animal model and, if so, what have they shown?
Schneiderman H. More Questions About Purpura Fulminans. Arch Dermatol. 1990;126(1):121. doi:10.1001/archderm.1990.01670250127026