Fatal pneumococcal purpura fulminans in an asplenic patient

Abstract

Splenectomized patients are at an increased risk of serious infection with encapsulated bacteria such as Streptococcus pneumoniae. Purpura fulminans is a rare complication of Streptococcus pneumoniae infections, and occurs with acute onset characterized by cutaneous ecchymoses, symmetrical gangrene of the extremities, renal failure and disseminated intravascular coagulation. A 41-year-old woman admitted to the emergency department with shivering, high fever and sore throat persisting for 2 days. It was learned that she had had a splenectomy 30 years ago and she was not regularly vaccinated with pneumococcal vaccine. After taking blood cultures, treatment with intravenous antibiotic was started. Within a short time, haemorrhagic and ecchimotic rashes occurred on her face and were spread throughout the body. Her condition rapidly deteriorated and she died within 36 hours. Streptococcus pneumoniae was identified in her blood culture.