Rare presentation of rickettsial infection as purpura fulminans: a case report

Abstract

BackgroundPurpura fulminans is an acute life-threatening disorder characterized by intravascular thrombosis and hemorrhagic infarction of the skin complicated with disseminated intravascular coagulation. It is commonly seen in acute infections following meningococcal and streptococcal infections. Few cases of purpura fulminans following rickettsial infections have been described in the literature.Case presentationWe report a case of a 55-year-old Sri Lankan woman who presented to Teaching Hospital Peradeniya with a febrile illness, headache, and myalgia that progressed to an erythematous rash starting over the bilateral lover limbs and hands and that became black and necrotic with a few hemorrhagic blebs. She had normocytic anemia, platelet clumps, and monocytosis as well as a deranged clotting profile. The result of immunofluorescence antibody testing for rickettsial immunoglobulin G was strongly positive for Rickettsia conorii with a rise in titer convalescent sera, and a diagnosis of purpura fulminans following rickettsial infection was made. The patient made an excellent recovery with chloramphenicol treatment.ConclusionsThe treating physician should consider the rare but very treatable condition of rickettsial infection as a differential diagnosis in the etiological diagnostic workup of patients presenting with severe purpuric and hemorrhagic rash with fever.

Differential Diagnosis and Workup of Monocytosis: A Systematic Approach to a Common Hematologic Finding

“…Persistent causes: A diverse group of subacute or chronic infections have been associated with monocytosis. These include syphilis [ 23 ], brucellosis [ 24 ], malaria [ 25 ], tuberculosis [ 26 ], visceral leishmaniasis [ 27 ], and rickettsial infection[ 28 ]. While these case reports and case series are intriguing, they should be interpreted with caution.…”

Recognition and treatment of devastating vasculopathic systemic disorders: Coronavirus disease 2019 and rickettsioses

“…An unusual manifestation of this disease is the development of a fern‐leaf shaped necrotic skin rash and purpura fulminans, which can progress to necrosis. Some of the most common infectious agents that can also cause purpura fulminans include Neisseria meningitidis , Pseudomonas aeruginosa , Haemophilus influenzae , and methicillin‐resistant S. aureus 36 …”

Purpura Fulminans in an Asplenic Intravenous Drug User

“…and varicella-zoster virus. 2,[7][8][9][10][11][12][13] Two earlier cases associated with Capnocytophaga were characterized by concomitant renal failure, metabolic acidosis, hemolytic anemia, and DIC. 14 It is estimated that Capnocytophaga causes 11% to 46% of all cases of sepsis 15 ; sepsis resulting from Capnocytophaga has extremely poor outcomes, with mortality reaching as high as 60%.…”