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Case Reports
. 2018 Nov 13;2(21):2917-2921.
doi: 10.1182/bloodadvances.2018024430.

Persistence of endothelial thrombomodulin in a patient with infectious purpura fulminans treated with protein C concentrate

Pavan K Bendapudi  1   2   3 , Alissa Robbins  4 , Nicole LeBoeuf  3   5 , Olga Pozdnyakova  3   6 , Ami Bhatt  7   8 , Fujiko Duke  4 , Ryan Sells  3   5 , John McQuiston  9 , Ben Humrighouse  9 , Betty Rouaisnel  4 , Meaghan Colling  1   3 , Kathryn E Stephenson  3   10   11 , Arturo Saavedra  12 , Julie-Aurore Losman  3   4   13   14
Affiliations
Case Reports

Persistence of endothelial thrombomodulin in a patient with infectious purpura fulminans treated with protein C concentrate

Pavan K Bendapudi et al. Blood Adv. .
No abstract available

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

Figure 1.
Figure 1.
Initial presentation and clinical course. (A) The patient as he appeared at presentation, following rapid development of a mask-like purpuric rash involving the face. (B) Polymorphonuclear leukocyte containing rod-like basophilic inclusions on Wright’s stain (arrowhead; left panel), and Gram’s stain (arrowhead; right panel). Original magnification ×1000. (C) Plasma levels of PC, antithrombin (AT), and lactate during the first 10 days of hospitalization. (D) Activated partial thromboplastin time (aPTT), prothrombin time (PT), and fibrinogen during the same period. PC and antithrombin concentrates were administered twice daily starting 6 hours after presentation through day 10 of hospitalization.
Figure 2.
Figure 2.
Time course of expression of TM and E-selectin. (A-E) Immunohistochemical staining for TM on blood vessels (arrowheads) in skin biopsy specimens taken at various time points during the patient’s hospitalization (days 1-28) and at convalescence (day 231) compared with a normal control specimen (scale bars, 20 µm). Staining for E-selectin, a marker of endothelial cell activation (F-J), and for ICAM-1, a marker of cell viability (K-O), in the same biopsy specimens. (P) Quantification of the immunohistochemical staining of TM, E-selectin, and ICAM-1 in (A-O), represented as fold change from day 0. Expression of TM and E-selectin returned to baseline at day 231. (Q) TM and E-selectin transcript levels normalized to GAPDH expression at each time point, as determined by real-time quantitative PCR. (R) Quantification of the patient’s convalescent TM and E-selectin transcript levels as a ratio of the transcript levels in a healthy subject.
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