Epidural sympathetic blockade to relieve vascular insufficiency in an infant with purpura fulminans

The patient in septic shock who develops vascular insufficiency secondary to purpura fulminans is a challenge to the healthcare team. Initial management is directed toward reversing the disease process by administering antibiotics immediately and initiating life-support measures. Emergency measures include optimizing oxygenation and ventilation, reestablishing and/or maintaining circulation and end-organ perfusion and correcting electrolyte imbalances and coagulopathies. After the emergent life-saving needs of the patient have been addressed, attention may be directed toward saving extremities. Epidural sympathetic blockade proved to be successful as an essential adjunctive intervention in preserving the lower extremities of our patient. We encourage other healthcare providers to consider this treatment to help decrease the morbidity of vascular insufficiency secondary to meningococcal purpura fulminans.