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  • Infectious purpura fulminans associated with pneumococcal septicaemia in a patient with unacknowledged functional asplenia

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Case Reports: Reminder of important clinical lesson
Infectious purpura fulminans associated with pneumococcal septicaemia in a patient with unacknowledged functional asplenia
  1. Savannah Duus1,
  2. Sanne Jespersen2 and
  3. Christian Wejse2,3
  1. 1Global health, Aarhus Universitet, Aarhus, Denmark
  2. 2Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
  3. 3Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
  1. Correspondence to Dr Savannah Duus; savannahduus{at}gmail.com

Abstract

Purpura fulminans (PF) is a life-threatening complication of septic shock that can occur due to disseminated infections with Streptococcus pneumoniae. The spleen is an important organ in the immunisation process against encapsulated bacteria. Patients with asplenia, either functional or anatomical, are therefore at increased risk of developing serious infections and complications, such as PF, if infected with such bacteria.

This case report presents a woman in her late 40s with unacknowledged functional asplenia who was admitted to the hospital with signs of an acute disseminated infection causing septic shock, signs of disseminated intravascular coagulation and infectious PF. A few days after admission, the blood cultures showed growth of S. pneumoniae. With early sepsis treatment, the patient survived although with some complications. Clinical presentation, investigations, differential diagnosis, treatment and outcome are presented. Treatment and early recognition of PF are presented and discussed. Relevant recognition and preventative treatment strategies for patients with asplenia are also reviewed and discussed.

This case demonstrates the importance of early recognition and treatment of PF in septic patients and the importance of preventive treatment strategies for patients with asplenia to avoid serious infections and complications.

  • Pneumonia (infectious disease)
  • Vaccination/immunisation
  • Purpura Fulminans

https://doi.org/10.1136/bcr-2022-251397

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    Footnotes

    • Contributors SD and CW were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. SJ gave final approval of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.