Septic Shock and Purpura Fulminans Due to Streptococcus pneumoniae Bacteremia in an Unvaccinated Immunocompetent Adult: Case Report and Review

Abstract

Rare co-existance of disease or pathology Background: Despite proven efficacy of vaccinations against Streptococcus pneumoniae in preventing infection, only 70% of eligible individuals receive the vaccine in the United States. Pneumococcal bacteremia represents a form of invasive pneumococcal disease and is associated with high mortality, especially in immunocompromised patients and the elderly. Purpura fulminans is a rare complication and manifestation of disseminated intravascular coagulation and sepsis. It is exceedingly rare in the setting of pneumococcal bacteremia, particularly in immunocompetent individuals. Case Report: We report a generally healthy 67-year-old male with schizophrenia who refused pneumococcal vaccination. He had an intact and functional spleen with a functional immune system. The patient presented with fever and diarrhea. He subsequently progressed to develop purpura fulminans and septic shock due to S. pneumoniae bacteremia. Despite an extensive search for the primary source of infection, none could not be identified. Due to timely initiation of appropriate antibiotic therapy and aggressive supportive care in an intensive care unit, he recovered despite multi-organ failure that developed throughout his hospitalization. Conclusions: We present a rare manifestation of a potentially preventable disease and emphasize the importance of pneumococcal vaccination in order to decrease the risk of developing invasive pneumococcal disease. Furthermore, we discuss etiology, diagnosis, differential diagnosis, and evidence-based management of purpura fulminans and invasive pneumococcal disease with a literature review. Purpura fulminans due to S. pneumoniae is exceedingly rare in immunocompetent patients and an unusual clinical manifestation of pneumococcal bacteremia.

Sternoclavicular Septic Arthritis Due to Invasive Pneumococcal Infection After Type A Influenza Virus Infection

“…However, S. pneumoniae can cause infections in any part of the body (such as endocarditis and arthritis), which is known as unusual IPD (uIPD) [ 5 ]. Djurdjevic et al reported a case of IPD and electric purpura in an adult with no underlying disease [ 6 ]. The patient was a 67-year-old male with no underlying disease of splenectomy, diabetes, or malignancy.…”

Pneumococcal purpura fulminans in a 25-year-old patient with liver cirrhosis due to autoimmune hepatitis

“…Pneumococcal infection is associated with the highest mortality rate in these patients, compared to other bacteria [12] . There have also been reports of pneumococcal PF in patients who are immunocompetent without asplenia or hyposplenia [13] , [14] .…”

Right Lower Extremity Phlegmasia Cerulea Dolens Due to Iliotibial Vein Thrombosis With Compartment Syndrome and Circulatory Shock: Case Report and Review

“…Risk factors for PCD include malignancy, occluded inferior vena cava filters, and other prothrombotic states such as hormone replacement or contraceptive use, pregnancy, trauma or long-distance travel [ 1 , 9 ]. The left lower extremity is four times more likely affected than the right since the left common iliac vein is more commonly compressed by the overlying left common iliac artery, predisposing to thrombosis.…”