Acute infectious purpura fulminans with Enterobacter aerogenes post-neurosurgery

Acute infectious purpura fulminans (AIPF) is a rare, life-threatening disease commonly caused by Neisseria meningitidis and Streptococcus pneumoniae. Gram-negative rods are rarely involved. We described a case of AIPF associated with Enterobacter bacteremia in a 48-year-old man admitted for subarachnoid hemorrhage treatment. After surgical clipping for intracranial aneurysms, septic shock, multiple organ failure, and extensive purpura on the skin developed. Enterobacter aerogenes bacteremia was detected and AIPF was diagnosed. His condition progressively worsened and he died on day 19. Autopsy showed multiple abscesses and thrombosis in the lung, intestinal tract, and kidney.