Index Copernicus IC Value: 85.42
International Journal of Case Reports and Images - IJCRI - Case Reports, Case Series, Case in Images, Clinical Images

     
Case Report
 
Streptococcus pneumoniae induced purpura fulminans in a patient with splenic hypoplasia
Shunsuke Kojima1, Eiji Hiraoka1, Jun Ehara1 Toshihiko Suzuki2, Enichi Nakatsuru3, Yasuhiro Norisue4
1MD, Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
2MD, Department of Nephrology, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
3MD, Department of Orthopedic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
4MD, Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan

Article ID: Z01201710CR10836SK
doi:10.5348/ijcri-201797-CR-10836

Address correspondence to:
Eiji Hiraoka
Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
3-4-32 Todaijima, Urayasu-city
Chiba, 279-0001
Japan

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How to cite this article
Kojima S, Hiraoka E, Ehara J, Suzuki T, Nakatsuru E, Norisue Y. Streptococcus pneumoniae induced purpura fulminans in a patient with splenic hypoplasia. Int J Case Rep Images 2017;8(10):634–638.


ABSTRACT

Purpura fulminans (PF) is a rare, life-threatening medical emergency requiring prompt diagnosis and treatment. Common causes include Neisseria meningitidis, Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae, Staphylococcus aureus, and fungal or viral infections. It usually occurs in immunocompromised hosts. We experienced a rare case of purpura fulminans due to S. pneumoniae,, who had no history of immunosuppressive disease. Case Report: A 57-year-old male was presented to our emergency department in shock state with flu-like symptoms. Empirical broad-spectrum antibiotics and intensive care were started. His condition rapidly deteriorated with multiple organ failure. Blood culture grew up S. pneumoniae,. Purpuric skin change developed in all extremities followed by ischemic gangrene, which required amputation. He did not have any history of immunosuppressive disease. His computed tomography scan of abdomen showed small size of spleen. Howell–Jolly bodies were recognized in peripheral blood smear. The patient was finally diagnosed with purpura fulminans with overwhelming pneumococcal sepsis. Although he had no history of immunodeficiency, he had evidence of Howell–Jolly bodies in peripheral blood smear, implying reduced splenic function, possibly due to splenic hypoplasia. To prevent this devastating condition, vaccination against S. pneumoniae, may need to be considered for people with splenic hypoplasia. Conclusion: Since delay in therapy would lead to a poor outcome, clinicians should be alert to purpura fulminans in patients in shock state, even lacking typical skin manifestation initially. Splenic hypoplasia may be a risk factor of this condition.

Keywords: Purpura fulminans, Streptococcus pneumoniae,, Erythrocyte inclusions, Splenic hypoplasia



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Author Contributions
Shunsuke Kojima – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Eiji Hiraoka – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jun Ehara – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Toshihiko Suzuki – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Enichi Nakatsuka – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Yasuhiro Norisue – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Shunsuke Kojima et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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