Purpura and gangrene in a septic patient. Purpura fulminans secondary to pneumococcal sepsis

Pm, Benson; Gp, Lupton; Wd, James

doi:10.1001/archderm.124.12.1851

Cited by 7 publications

(1 citation statement)

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“…3 The mechanism of purpura during these infections is most often a manifestation of underlying disseminated intravascular coagulation, stimulated by endotoxin-induced immune complexes or complement activation. 2,10 Most cases of purpura fulminans due to S. pneumoniae infections occur in asplenic or immunocompromised patients [11][12][13] ; cases among immunocompetent persons are less common. 3,[14][15][16][17][18][19] Purpura as the sole manifestation of S. pneumoniae has been reported only once before in an immunocompetent 4-month old who presented with purpura without other clinical manifestations; blood cultures grew pneumococcus, and the patient had an uneventful recovery.…”

Section: Discussionmentioning

confidence: 99%

Purpura-Producing Streptococcus pneumoniae

Crum¹,

Lederman²

2004

Infectious Diseases in Clinical Practice

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Clinical manifestations of purpura-producing Streptococcus pneumoniae may mimic meningococcemia. The pathogenesis of S. pneumoniae purpura has been elucidated, but clinical cases of benign purpura due to this organism are rare. We report the first case of purpura-producing S. pneumoniae occurring in the setting of uncomplicated community-acquired pneumonia in an immunocompetent adult. (Infect Dis Clin Pract 2004;12:288-290) CASE REPORTAn 18-year-old male presented with a 3-week history of rhinorrhea that progressed to fevers, a dry cough, and chills over the 4 days before admission. The patient noted a rash that began on both ankles and spread proximally to his distal thighs 2 days before admission. The rash was not painful or pruritic. He denied headache, confusion, dyspnea, or chest pain. He was without any significant past medical or surgical history and was on no medications. He had moved to San Diego, CA, from Texas one month before presentation after enlisting in the US Marines. He reported no exposures to ticks or animals. Standard Basic Training-related immunizations 1 month before admission included the pneumococcal and meningococcal vaccines. On examination, his temperature was 38.28C, pulse of 78 beats per minute, blood pressure 110/59 mm Hg, respiratory rate of 20 breaths per minute, and oxygen saturation of 99%. He was ill-appearing. His lungs had decreased breath sounds in the left lower lobe with accompanying crackles. Skin examination showed a nonblanching, nonpalpable, purpuric rash extending from both ankles to his thighs (Fig. 1). He had no other cutaneous findings, and the remainder of his examination was normal.Laboratory values included a white blood cell count of 15,100 cells/mm 3 , hemoglobin of 13.2 mg/dL, platelets 263,000, and a normal chemistry panel. Liver function tests were normal except for an albumin of 2.6 mg/dL. International Normalized Ratio was elevated at 1.4 with a prothrombin time of 13.8 seconds, and partial thromboplastin time of 34.3 seconds; a disseminated intravascular coagulation panel was negative. The elevated INR resolved over 48 hours without any specific therapy. Chest radiograph demonstrated a left lower lobe infiltrate without effusion or adenopathy.The patient was treated with ceftriaxone 2 g intravenously and levofloxacin 500 mg daily for community-acquired pneumonia. He continued to have temperatures of up to 39.18C for the first 36 hours and then became afebrile. Given the possibility of Neisseria meningitidis, 80 men who slept in the same room in the barracks received a single dose of levofloxacin (500 mg).A workup for the etiology of the patient's illness included 2 sets of blood cultures; Chlamydia pneumoniae and Mycoplasma pneumoniae IgM and IgG serologies; viral cultures for adenovirus, respiratory syncytial virus, influenzae, and parainfluenzae (Rhinoprobe); an antistreptolysin O titer; and throat culture for group A streptococcus and N. meningitidis. All of these tests were negative. The patient was unable to produce a sputum sample despite multi...

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Section: Discussionmentioning

confidence: 99%

Purpura-Producing Streptococcus pneumoniae

Crum¹,

Lederman²

2004

Infectious Diseases in Clinical Practice

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The Nail in Systemic Diseases and Drug‐Induced Changes

Tosti

Baran²,

Dawber

2001

Baran and Dawber's Diseases of the Nails and Their Management

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Acrokeratosis paraneoplastica of Bazex

Handfield‐Jones

Matthews²,

Ellis³

et al. 2004

Dermatology Therapy

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squamous cell carcinomas, both adenocarcinoma"l Ba&ed on Bazex disease is one of the rarer cutaneous paraneoand carcinoid tumourse have been reported. case presented plastic syndromes. It is characterized by psoriasiform In many patients the severity of the cutaneous to Section of changes on the digits, and in soinw patients spread changes parallel the extent ofthe tumour, but in some DerMaytlo991, to the ears, nose and in later stages to the limbs and case the cutaneous changes can either precede3'9 or trunk. The associated malignancyis. typicallya follow5 the-development Of the tumour-by many squamous cell carcinoma of the upper aerodigestive months. In those cases where the tumour has been tract. We review the literature regarding acrokeratosis treatable the skin lesions have improved as the paraneoplastica of Bazex and report three cases which 'tumour regressed, only to recur with tumour relapse. illustrate both the typical and some of the less Local treatment to the skin usuBally fails to clear the common changes that are seen in-the condition. lesions. Recent reports suggest that there may be a good response to systemic retinoids514.

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Purpura and gangrene in a septic patient. Purpura fulminans secondary to pneumococcal sepsis

Cited by 7 publications

References 0 publications

Purpura-Producing Streptococcus pneumoniae

Purpura-Producing Streptococcus pneumoniae

The Nail in Systemic Diseases and Drug‐Induced Changes

Acrokeratosis paraneoplastica of Bazex

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