In later stage lesions, there is irreversible endothelial ischaemic injury with extravasation of blood cells into the dermis and gangrenous necrosis, sometimes with secondary infection.The depletion of anticoagulant and anti-inflammatory proteins, in particular, protein C and its co-factor, protein S, may also promote thrombus formation, inhibit fibrinolysis and lead to further activation of the inflammatory pathways. Diagnosis
Early purpura fulminans lesions look similar to traumatic skin bleeds or purpuric rashes, such as immune thrombocytopenic purpura or thrombotic thrombocytopenic purpura; however, purpura fulminans will rapidly progress to necrosis whereas other purpuric rashes do not. In most cases, differential diagnoses may be distinguished from purpura fulminans by other clinical and laboratory findings.The initial appearance of purpura fulminans lesions is of well-demarcated erythaamatous lesions which progress rapidly to develop irregular central areas of blue-black haemorrhagic necrosis. Advancing areas of necrosis are often surrounded by a thin border of erythaema that fades into adjacent unaffected skin. Haemorrhage into the necrotic skin causes purpura fulminans lesions to become painful, dark and raised, sometimes with vesicle or blister (bulla) formation.The distribution of purpura fulminans lesions may be different according to the underlying pathogenesis. Purpura fulminans in severe sepsis typically develops in the distal extremities and progresses proximally or appears as a generalised or diffuse rash affecting the whole body surface. In cases of severe inheritable protein C deficiency, purpura fulminans with disseminated intravascular coagulation manifests within a few hours or days after birth.
The ecclesiastical title of archpriest or archpresbyter belongs to certain priests with supervisory duties over a number of parishes. The term is most often used in Eastern Orthodoxy and the Eastern Catholic Churches and may be somewhat analogous to a monsignor, vicar forane or dean in the Latin Church, but in the Eastern churches an archpriest wears an additional vestment and, typically, a pectoral cross, and becomes an archpriest via a liturgical ceremony. The term may be used in the Latin Catholic Church in certain historical titles and may replace in popular usage the title of vicar forane, otherwise often known as a dean. Antiquity
In ancient times, the archdeacon was the head of the deacons of a diocese, as is still the case in the Eastern Orthodox Church, while the archpriest was the chief of the presbyerate of the diocese, i.e. of the priests as a body. The latters  duties included deputising for the bishop in spiritual matters when necessary. Western Christianity
Latin Catholic Church
In the western Church, by the Middle Ages, the use of the title had evolved and became assigned to the priest of the principal parish among several local parishes. This priest had general charge of worship in this archpresbyterate, and the parishioners of the smaller parishes had to attend Sunday Mass and hold baptisms at the principal parish while the subordinate parishes instead held daily mass and homilies.