Purpura Fulminans in a Patient With Septic Shock due to Escherichia coli Bacteremia With Emphysematous Pyelitis

Abstract

Purpura fulminans (PF) is a rapidly fatal disorder predominantly encountered in patients with an acquired deficiency of physiologic anticoagulants due to severe sepsis and septic shock with disseminated intravascular coagulation (DIC). This consumptive process eventually leads to widespread thrombosis, hemorrhagic necrosis, and gangrene. Rapid identification followed by aggressive management of the underlying etiology with a multidisciplinary team is critical to prevent long-term organ dysfunction, disability from amputation, and death. While bleeding is a common finding in DIC, anticoagulation must be considered if PF is present. We report a case of Escherichia coli-associated emphysematous pyelitis leading to bacteremia, septic shock, and PF with small-and medium-sized vessel thrombosis and acral ischemia.

A Rare Cause of a Rare Disorder: E. coli-Induced Purpura Fulminans Secondary to Urinary Tract Infection

“…TTP, HSP, and postinfectious thrombocytopenic purpura are all secondary skin lesions like PF but do not match the severity of the necrosis seen in our patient and therefore were ruled out. The case reported by Morales et al is very similar to our case both in the presentation and the management [ 9 ]. Both cases highlight the importance of nurturing a high clinical suspicion for PF in the presence of purpuric skin lesions in septic patients even in the absence of a classic picture of DIC.…”

“…Rare cases associated with measles virus, Rickettsia spp., and Haemophilus influenzae have also been reported in the medical literature [ 8 ]. E. coli -septicemia-associated PF is rare; only a handful of cases have been reported [ 9 – 11 ]. PF may occur because of an acute infection even in asymptomatic, afebrile, or otherwise well-appearing individuals from pediatrics to adults, but it may also transpire in the post-infectious setting.…”

Púrpura fulminante aguda concomitante con proceso infeccioso pulmonar

“…Se cree que la causa es una deficiencia relativa de proteína S . De entre las múltiples infecciones descritas, las más comunes son la varicela y las infecciones estreptocócicas, que se (6) presentan en 30% y 20% de los pacientes, respectivamente .…”

Cutaneous Manifestations of Malaria and Their Prognostic Windows: A Narrative Review

“…Commonly suspected organisms include gram-negative cocci, gram-positive bacteria, and parasites such as malaria [ 4 ]. Plasmodium falciparum infection is noted to be associated with low levels of protein C, protein S, tissue plasminogen activator, and antithrombin with an increased level of plasminogen activator inhibitor-1 [ 4 , 5 ].…”