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Purpura Fulminans Secondary to Streptococcus pneumoniae Meningitis

Erick F Alvarez1, Karen E Olarte, Mayur S Ramesh

  • 1Infectious Diseases Division, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202, USA.

Case Reports in Infectious Diseases
|May 9, 2012
PubMed

Insights

Purpura fulminans (PF), a rare skin disorder, can present with disseminated intravascular coagulation (DIC) and skin necrosis. Early recognition of bacterial meningitis, even with normal initial CSF analysis, is crucial for prompt PF treatment.

Area of Science:

  • Dermatology
  • Hematology
  • Infectious Diseases

Background:

  • Purpura fulminans (PF) is a rare, severe dermatological condition characterized by extensive violaceous, hemorrhagic skin necrosis.
  • Patients with PF often exhibit laboratory evidence of disseminated intravascular coagulation (DIC), a life-threatening systemic coagulopathy.

Observation:

  • A case study details a 37-year-old male presenting with malaise, headache, vomiting, photophobia, and an ecchymotic rash.
  • Initial diagnostics revealed DIC without a clear infectious source, including normal cerebrospinal fluid (CSF) biochemistry.
  • The patient's condition progressed to multiorgan damage consistent with PF, with subsequent CSF cultures identifying Streptococcus pneumoniae.

Findings:

  • Unexplained disseminated intravascular coagulation (DIC) and purpura fulminans (PF) should prompt consideration of bacterial meningitis, even with initially normal CSF analysis.
  • Streptococcus pneumoniae was identified as the causative agent in a case of PF with DIC, highlighting infection as a potential trigger.

Implications:

  • Early recognition and prompt empirical treatment of PF are critical, particularly in patients with altered mental status, ecchymotic rash, and DIC.
  • This case underscores the importance of considering infectious etiologies, such as bacterial meningitis, in the differential diagnosis of unexplained DIC and PF.
  • Timely CSF analysis and culture are vital for identifying infectious triggers in patients presenting with PF and DIC.

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