Persistence of endothelial thrombomodulin in a patient with infectious purpura fulminans treated with protein C concentrate by Pavan K. Bendapudi, Alissa.

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Persistence of endothelial thrombomodulin in a patient with infectious purpura fulminans treated with protein C concentrate by Pavan K. Bendapudi, Alissa Robbins, Nicole LeBoeuf, Olga Pozdnyakova, Ami Bhatt, Fujiko Duke, Ryan Sells, John McQuiston, Ben Humrighouse, Betty Rouaisnel, Meaghan Colling, Kathryn E. Stephenson, Arturo Saavedra, and Julie-Aurore Losman BloodAdv Volume 2(21):2917-2921 November 13, 2018 ©2018 by American Society of Hematology

Initial presentation and clinical course. 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. Pavan K. Bendapudi et al. Blood Adv 2018;2:2917-2921 ©2018 by American Society of Hematology

Time course of expression of TM and E-selectin. 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. Pavan K. Bendapudi et al. Blood Adv 2018;2:2917-2921 ©2018 by American Society of Hematology