Purpura Fulminans: a Rare but Fierce Presentation of Pneumococcal Sepsis

Infectious purpura fulminans (PF) is a rare presentation of disseminated intravascular coagulopathy (DIC) due to diffuse intravascular thrombosis and haemorrhagic infarction of the skin. PF can present in infancy/childhood or adulthood and usually presents as ecchymotic skin lesions, fever and hypotension. It is most commonly a consequence of sepsis related to Neisseria meningitidis, Streptococcus pneumoniae or Haemophilus influenzae. Despite aggressive management of sepsis with intravenous fluids, antibiotics, and conventional and nonconventional therapies, the condition still carries a mortality rate of 43%([1]). Streptococcus pneumoniae mostly presents with community-acquired pneumonia. We present a case of PF secondary to DIC related to Pneumococcal sepsis in an otherwise healthy and immunocompetent patient. LEARNING POINTS: Infectious purpura fulminans is a haematological emergency that demands early recognition and timely institution of therapy to prevent significant morbidity and mortality. A characteristic skin rash is a key diagnostic clue pointing to purpura fulminans, and should lead to prompt institution of therapy, as waiting for a skin biopsy result can delay the diagnosis and result in significant morbidity and mortality. Due to the lack of prospective data on management of the condition, various modalities, such as hyperbaric oxygen therapy and IVIG, still have questionable benefits. We therefore aim to expand knowledge of purpura fulminans management.