Purpura Fulminans: a Rare but Fierce Presentation of Pneumococcal Sepsis

Adeel Nasrullah; Anam Javed; Usman Tariq; Meilin Young; Zunera Moeen; Marvin Balaan

doi:10.12890/2019_001373

Purpura Fulminans: a Rare but Fierce Presentation of Pneumococcal Sepsis

Eur J Case Rep Intern Med. 2019 Dec 30;7(1):001373. doi: 10.12890/2019_001373. eCollection 2020.

Authors

Adeel Nasrullah¹, Anam Javed², Usman Tariq¹, Meilin Young³, Zunera Moeen⁴, Marvin Balaan³

Affiliations

¹ Department of Internal Medicine, Allegheny Health Network; Pittsburgh, USA.
² Department of Internal Medicine, University College of Medicine and Dentistry, Lahore, Pakistan.
³ Departement of Pulmonology and Critical care, Allegheny Health Network, Pittsburgh, USA.
⁴ Department of Internal Medicine, Texas Tech Permian Basin, Odessa, USA.

Abstract

Infectious purpura fulminans (PF) is a rare presentation of disseminated intravascular coagulopathy (DIC) due to diffuse intravascular thrombosis and haemorrhagic infarction of the skin. PF can present in infancy/childhood or adulthood and usually presents as ecchymotic skin lesions, fever and hypotension. It is most commonly a consequence of sepsis related to Neisseria meningitidis, Streptococcus pneumoniae or Haemophilus influenzae. Despite aggressive management of sepsis with intravenous fluids, antibiotics, and conventional and nonconventional therapies, the condition still carries a mortality rate of 43%^[1]. Streptococcus pneumoniae mostly presents with community-acquired pneumonia. We present a case of PF secondary to DIC related to Pneumococcal sepsis in an otherwise healthy and immunocompetent patient.

Learning points: Infectious purpura fulminans is a haematological emergency that demands early recognition and timely institution of therapy to prevent significant morbidity and mortality.A characteristic skin rash is a key diagnostic clue pointing to purpura fulminans, and should lead to prompt institution of therapy, as waiting for a skin biopsy result can delay the diagnosis and result in significant morbidity and mortality.Due to the lack of prospective data on management of the condition, various modalities, such as hyperbaric oxygen therapy and IVIG, still have questionable benefits. We therefore aim to expand knowledge of purpura fulminans management.

Keywords: Purpura fulminans; Streptococcus pneumoniae; hyperbaric oxygen therapy; sepsis.