Details

Autor(en) / Beteiligte

• Kojima, Shunsuke
• Hiraoka, Eiji
• Ehara, Jun
• Suzuki, Toshihiko
• Nakatsuru, Enichi
• Norisue, Yasuhiro

Titel

Streptococcus pneumoniae induced purpura fulminans in a patient with splenic hypoplasia

Ist Teil von

• International Journal of Case Reports and Images (IJCRI), 2017-10, Vol.8 (10), p.634-638

Ort / Verlag

Edorium Journals

Erscheinungsjahr

2017

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• Introduction: Purpura fulminans (PF) is a rare, life-threatening medical emergency requiring prompt diagnosis and treatment. Common causes include Neisseria meningitidis, Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae, Staphylococcus aureus, and fungal or viral infections. It usually occurs in immunocompromised hosts. We experienced a rare case of purpura fulminans due to S. pneumoniae, who had no history of immunosuppressive disease. Case Report: A 57-year-old male was presented to our emergency department in shock state with flu-like symptoms. Empirical broad-spectrum antibiotics and intensive care were started. His condition rapidly deteriorated with multiple organ failure. Blood culture grew up S. pneumoniae. Purpuric skin change developed in all extremities followed by ischemic gangrene, which required amputation. He did not have any history of immunosuppressive disease. His computed tomography scan of abdomen showed small size of spleen. Howell–Jolly bodies were recognized in peripheral blood smear. The patient was finally diagnosed with purpura fulminans with overwhelming pneumococcal sepsis. Although he had no history of immunodeficiency, he had evidence of Howell-Jolly bodies in peripheral blood smear, implying reduced splenic function, possibly due to splenic hypoplasia. To prevent this devastating condition, vaccination against S. pneumoniae may need to be considered for people with splenic hypoplasia. Conclusion: Since delay in therapy would lead to a poor outcome, clinicians should be alert to purpura fulminans in patients in shock state, even lacking typical skin manifestation initially. Splenic hypoplasia may be a risk factor of this condition.