title: Purpura fulminans associated with Streptococcus pneumoniae septicemia in an asplenic pediatric patient.
abstract: Purpura fulminans is a rapidly progressive syndrome of small-vessel thrombosis and hemorrhagic necrosis of the skin accompanied by disseminated intravascular coagulation. We describe a case of Streptococcus pneumoniae septicemia in an asplenic 5-year-old boy on oral tacrolimus, with a past medical history of multivisceral organ transplantation and subsequent development of purpura fulminans on his chest and distal extremities. The acute infectious form of purpura fulminans is usually caused by gram-negative bacteria. Cases secondary to gram-positive encapsulated bacteria usually occur when individuals are immuno-suppressed or have anatomic or functional asplenia. Our patient had both, which likely increased his susceptibility, and he responded well to antimicrobial therapy in addition to prophylactic coverage in the setting of his immunosuppression. We review the literature for similar cases due to S. pneumoniae in the pediatric population and discuss the etiology and treatment of purpura fulminans.
authors.affiliation: Department of Dermatology, Howard University College of Medicine, Washington, DC, USA.
authors.forename: S
authors.initials: S
authors.lastname: Konda
authors.forename: D
authors.initials: D
authors.lastname: Zell
authors.forename: C
authors.initials: C
authors.lastname: Milikowski
authors.forename: J
authors.initials: J
authors.lastname: Alonso-Llamazares
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications* / Q000382:microbiology; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D006440:Hemofiltration; D018197:Hepatoblastoma / Q000601:surgery; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology / Q000628:therapy; D016867:Immunocompromised Host; D007422:Intestines / Q000637:transplantation; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D016035:Pancreas Transplantation; D022242:Pneumococcal Vaccines; D011183:Postoperative Complications / Q000209:etiology* / Q000382:microbiology; D055665:Purpura Fulminans / Q000188:drug therapy / Q000209:etiology*; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy; D013156:Splenectomy; D013270:Stomach / Q000637:transplantation; D013290:Streptococcal Infections / Q000150:complications*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines
keywords: Asplenia; Coagulación intravascular diseminada; Disseminated intravascular coagulation; Hemorrhagic necrosis; Immunosuppression; Inmunosupresión; Necrosis hemorrágica; Purpura fulminans; Púrpura fulminante; Sepsis; Streptococcus pneumoniae; Thrombosis; Trombosis