Snapshot A newborn baby girl with no birth complications develops red purpuric lesions on the buttocks, elbows, and heels. She is lethargic and does not respond to soothing ointments. A pediatric dermatologist is consulted. By the time, the specialist sees the newborn, black eschars have formed on the pressure points. She is diagnosed with purpura fulminans and dies shortly after. Introduction Hypercoagulable state/thrombophilia caused by deficiency in protein C or S Mnemonics login to view 4 more bullets ETIOLOGY Pathogenesis login to view 6 more bullets Genetics login to view 7 more bullets Presentation Symptoms of thrombosis login to view 4 more bullets In severe cases login to view 3 more bullets STUDIES Protein C or S functional assay (preferred) login to view 1 more bullet Plasma protein C or S antigen levels login to view 1 more bullet Genetic testing not routinely done Differential Diagnosis Factor V Leiden mutation Antithrombin deficiency Antiphospholipid syndrome HIT Treatment Prevention login to view 3 more bullets For thrombosis login to view 2 more bullets For warfarin-induced necrosis login to view 4 more bullets Complications Miscarriage Thrombosis neonatal purpura fulminans Prognosis Severe disease associated with neonatal mortality Risk of warfarin-induced skin necrosis