Primary vaginal malignant melanoma is an extremely rare and aggressive tumor with very few reported cases worldwide. It often occurs in post-menopausal women, with a mean age of 57 years. The most common presenting symptom is vaginal bleeding. Other less common presenting symptoms are vaginal discharge, vaginal mass, and pain. Vaginal melanomas are often diagnosed at an advanced stage, and despite the aggressive treatment approach, the prognosis is poor. We present to you a case of a 56-year-old postmenopausal woman who presented with intermittent vaginal bleeding and passage of dark clots. She was found to have symptomatic anemia requiring blood transfusions. Further workup revealed a mass in the upper vagina on imaging studies, and the patient eventually underwent a biopsy, which confirmed the diagnosis of malignant melanoma of the vagina on pathological examination.

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We report this rare case of fatal fulminant sepsis in a 42-year-old African American female who presented with a three-day history of generalized pain and an evolving rash all over her body. On presentation, the patient was tachycardic, borderline hypotensive, and febrile. Physical examination was significant for diffuse petechiae and ecchymoses over the extremities, torso, and the face, especially confluent over her thighs and lower abdomen. She was admitted to the ICU, and initial investigations revealed a normal leukocyte count and hemoglobin but severe thrombocytopenia, elevated creatinine, blood urea nitrogen (BUN), bilirubin, transaminases, and an elevated INR. She also had a high anion gap metabolic acidosis with elevated lactate. Chest and abdomen CT findings were nonspecific, demonstrating fluid surrounding both kidneys, a moderate amount of fluid in the pelvis, and alveolar opacities at the bases of both lungs. Initial working diagnoses were a septic shock, thrombotic thrombocytopenic purpura (TTP), and vasculitis. She was initiated on broad-spectrum antibiotic coverage with vancomycin, piperacillin/tazobactam, and doxycycline pending culture reports. After a few hours, she became progressively hypothermic, developed disseminated intravascular coagulation (DIC) and hemodynamic instability, and was intubated due to acute hypoxic and hypercapnic respiratory failure. She progressively worsened hemodynamically with multi-organ dysfunction, and ultimately was pronounced dead roughly 18 hours after initial presentation. Blood cultures grew a Gram-negative organism, initially reported as Shewanella putrefaciens, but subsequently confirmed as Capnocytophaga canimorsus.