Purpura Fulminans in the Setting of Klebsiella Pneumoniae Bacteremia and Acetaminophen Overdose

Nguyen, Vincent; Myint, Janine; Philipneri, Marie

doi:10.7759/cureus.11633

Cited by 5 publications

(10 citation statements)

References 10 publications

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“…Laboratory findings associated with PF include prolonged coagulation time, decreased fibrinogen level, elevated D-dimer level, abnormalities in protein C function, and thrombocytopenia [2,5]. Thrombotic complications can even worsen after the clearance of the culprit organism using antibiotics [5]. This situation was observed in our patient after days of supportive care and intravenous ceftriaxone treatment, where we found some, but not complete, improvement in clinical and laboratory markers.…”

Section: Infectious Causes Of Purpura Fulminans [2]mentioning

confidence: 47%

“…The pathophysiology involves a disruption of coagulation homeostasis resulting from infection by endotoxin-producing gram-negative bacteria as observed in our case with K. pneumoniae infection. Along with the resulting inflammatory state, these endotoxins induce the consumption of proteins C and S and antithrombin III, creating a procoagulative state that causes dermal vessel coagulation [4,5]. Infections with gram-positive, anaerobic organisms or viruses [4] have also been documented.…”

Section: Discussionmentioning

confidence: 99%

“…Later in the course, hemorrhagic bullae may form, contributing to the classic hard eschar formation in PF. Laboratory findings associated with PF include prolonged coagulation time, decreased fibrinogen level, elevated D-dimer level, abnormalities in protein C function, and thrombocytopenia [2,5]. Thrombotic complications can even worsen after the clearance of the culprit organism using antibiotics [5].…”

Section: Infectious Causes Of Purpura Fulminans [2]mentioning

confidence: 99%

“…In 2020, Nguyen et al [5] published a case report where only two other cases of PF caused by K. pneumoniae were found in the literature. To our knowledge, and after an extensive literature search, the present report makes a total of four cases, indicating the extremely rare presentation of this condition.…”

Section: Infectious Causes Of Purpura Fulminans [2]mentioning

confidence: 99%

“…When bacterial septicemia is a cause of PF, the most common bacterial cultures reported in the medical literature are gram-positive cocci such as Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae [3,4]. Among other unique and occurring cases described in published reports, to the best of our knowledge, only three other cases involved Klebsiella pneumoniae [5]. Therefore, this case report on PF can be considered rare and complicated in the setting of K. pneumoniae bacteremia.…”

Section: Introductionmentioning

confidence: 99%

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A Rare Case of Purpura Fulminans in the Setting of Klebsiella pneumoniae Bacteremia

Villa¹,

Charles²,

Okonoboh³

2022

Cureus

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A 23-year-old man with circulatory shock associated with severe sepsis and congestive heart failure with an ejection fraction of 10% resulting in anasarca and multiorgan failure was admitted to our hospital's intensive care unit. Hours after admission, he developed a rash on his left inner thigh, which was later diagnosed as purpura fulminans (PF). Blood cultures were consistent with Klebsiella pneumoniae bacteremia, with community-acquired pneumonia being the possible source.PF is a rare and difficult-to-diagnose entity characterized by dysregulated hemostasis that is often associated with poor prognosis and fatal outcomes. To our knowledge, there are limited reports in the literature on K. pneumoniae as a cause of PF. Given the rarity of this presentation, this case will serve as an opportunity to report and discuss the pathophysiology of this disease for the benefit of physicians.

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Section: Infectious Causes Of Purpura Fulminans [2]mentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Infectious Causes Of Purpura Fulminans [2]mentioning

confidence: 99%

Section: Infectious Causes Of Purpura Fulminans [2]mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Rare Case of Purpura Fulminans in the Setting of Klebsiella pneumoniae Bacteremia

Villa¹,

Charles²,

Okonoboh³

2022

Cureus

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Klebsiella‐induced acute infectious purpura fulminans in a Thai woman: Case report and review of literature

Temnithikul

Rungrunanghiranya

Limtanyakul

et al. 2022

Skin Health and Disease

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Purpura fulminans (PF) is an uncommon syndrome of acute purplish skin eruption characterized by coagulation of the microvasculature, which leads to purplish lesions and skin necrosis. There are three subtypes; idiopathic PF, neonatal PF and, the most common subtype, acute infectious PF (AIPF). Acute infectious PF is related to the thrombotic subtype of disseminated intravascular coagulation (DIC) and usually is superimposed on sepsis. This can rapidly lead to multi‐organ failure from thrombotic occlusion of small and medium‐sized blood vessels. We report a case of Klebsiella‐induced AIPF in a 78‐year‐old Thai woman and also review other published cases.

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A Rare Case of Acute Infectious Purpura Fulminans Caused by Klebsiella Pneumoniae and Human Herpesvirus Type 5

Li¹,

Luan²,

Fan³

et al. 2022

JIR

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Background: Purpura fulminans (PF), a rare, life-threatening disorder, is a hematological emergency in which there is skin necrosis, disseminated intravascular coagulation (DIC), and protein C deficiency. In PF, the skin necrosis and DIC are secondary to protein C deficiency. This may progress rapidly to multiorgan failure caused by the thrombotic occlusion of small-and medium-sized blood vessels.Case Report: This article presents the case of a 22-year-old male with fever as well as necrotic and purpuric skin lesions. The ultrasound and computed tomography scans revealed infections in the skin wounds as well as venous microthrombosis and thrombosis in multiple intracranial and pulmonary vessels. The laboratory tests showed signs of sepsis, thrombocytopenia, an abnormal decrease in protein C and antithrombin III, DIC, multiple organ and system failures, gastric varices, and gastrointestinal hemorrhage. The blood, sputum, and secretions under the skin lesions were cultured and were positive for Klebsiella pneumoniae. The results of the highthroughput genetic testing of the pathogenic microorganism DNA were consistent. In addition, human herpesvirus type 5 was detected. The histopathological examination of the skin lesions revealed pathological features consistent with PF. After successful treatment by the departments of Dermatology, Emergency Critical Care Medicine, and the Intensive Care Unit, the patient was discharged after 67 days of hospitalization. Conclusion: Adults with acquired protein C and/or S deficiency states, including certain bacterial and viral infections, who drink alcohol and take varieties of non-steroidal anti-inflammatory analgesics at the same time, may develop acute infectious PF. Clinicians should be aware of this for early diagnosis and treatment.

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Purpura Fulminans in the Setting of Klebsiella Pneumoniae Bacteremia and Acetaminophen Overdose

Cited by 5 publications

References 10 publications

A Rare Case of Purpura Fulminans in the Setting of Klebsiella pneumoniae Bacteremia

A Rare Case of Purpura Fulminans in the Setting of Klebsiella pneumoniae Bacteremia

Klebsiella‐induced acute infectious purpura fulminans in a Thai woman: Case report and review of literature

A Rare Case of Acute Infectious Purpura Fulminans Caused by Klebsiella Pneumoniae and Human Herpesvirus Type 5

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