From the Research
There are approximately 30-50 case reports of purpura fulminans secondary to Streptococcus pneumoniae infection documented in the medical literature, as reported in the most recent study 1. Purpura fulminans is a rare but severe complication characterized by rapidly progressive hemorrhagic necrosis of the skin and disseminated intravascular coagulation. When caused by S. pneumoniae, it typically occurs in patients with functional or anatomic asplenia, immunocompromised states, or following pneumococcal pneumonia. The condition requires immediate recognition and aggressive management including appropriate antibiotics (typically high-dose intravenous ceftriaxone 2g every 12 hours or vancomycin 15-20mg/kg every 8-12 hours if penicillin resistance is suspected), intensive care support, and often surgical debridement of necrotic tissue. Some key points to consider in the management of purpura fulminans include:
- Early recognition and diagnosis are crucial to prevent significant morbidity and mortality, as highlighted in 2 and 3.
- The pathophysiology involves bacterial endotoxins triggering widespread coagulation, microvascular thrombosis, and protein C pathway dysfunction.
- Despite its rarity, the mortality rate remains high at approximately 30-50%, with survivors often facing significant morbidity including limb amputations and extensive skin grafting, as noted in 1 and 4.
- Pneumococcal vaccination is essential in preventing invasive pneumococcal disease, especially in individuals with a history of alcohol abuse or other immunocompromised states, as emphasized in 1. It is essential to prioritize the management of purpura fulminans based on the most recent and highest quality evidence, which in this case is the 2023 study 1.