Pneumococcal sepsis-induced purpura fulminans in an asplenic adult patient without disseminated intravascular coagulation

Am J Med Sci. 2013 Dec;346(6):514-6. doi: 10.1097/MAJ.0b013e31829e02d3.


Acute perturbations in the hemostatic balance of anticoagulation and procoagulation antecede the manifestation of purpura fulminans, a rare syndrome of intravascular thrombosis and hemorrhagic infarction of the skin. Hallmarks include small vessel thrombosis, tissue necrosis and disseminated intravascular thrombosis. The course may be rapidly fulminant resulting in multiorgan failure with thrombotic occlusion of the vasculature, leading to distal extremity ischemia and necrosis. Depletion of protein C (PC) has been emphasized in the pathogenesis. Early intravenous antibiotic administration and hemodynamic support are cornerstones in management. Herein, we report a case of pneumococcal sepsis-induced purpura fulminans limited to the skin in an asplenic adult patient without the development disseminated intravascular coagulation.

Publication types

  • Case Reports

MeSH terms

  • Administration, Intravenous
  • Amputation, Surgical
  • Anti-Bacterial Agents / therapeutic use
  • Ceftriaxone / therapeutic use
  • Debridement
  • Female
  • Fingers / surgery
  • Hand / surgery
  • Humans
  • Leg / surgery
  • Middle Aged
  • Pneumococcal Infections / complications
  • Pneumococcal Infections / etiology*
  • Pneumococcal Infections / microbiology
  • Pneumococcal Infections / therapy*
  • Purpura Fulminans / blood
  • Purpura Fulminans / microbiology*
  • Purpura Fulminans / pathology
  • Purpura Fulminans / therapy*
  • Purpura, Thrombocytopenic, Idiopathic / etiology
  • Sepsis / complications*
  • Sepsis / therapy*
  • Skin Transplantation
  • Splenectomy
  • Streptococcus pneumoniae / isolation & purification
  • Streptococcus pneumoniae / physiology
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Ceftriaxone