Dataset Information

Purpura fulminans manifesting with Staphylococcus aureus endocarditis: a case report.

ABSTRACT:

Background

Purpura fulminans (PF) is a haematologic emergency that can occur in the setting of severe septic shock. Its pathophysiology is not well-understood; however, some evidence suggests it may be mediated by excessive protein C consumption.

Case summary

In this case report, we describe a patient with PF secondary to methicillin-resistant Staphylococcus aureus endocarditis. She presented with severe septic shock and, despite haemodynamic improvement, developed a significant purpuric rash. Diagnostic work-up was notable for severely decreased serum levels of protein C. This patient was successfully treated with protein C concentrate and surgical valve replacement.

Discussion

While PF is rarely associated with S. aureus infection, this presentation may be more frequently encountered among clinicians in the current opioid epidemic. Quick recognition is crucial and a multidisciplinary approach, including intravenous infusion of protein C, may be considered.

SUBMITTER: Kumar A

PROVIDER: S-EPMC6601163 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Publications

Purpura fulminans manifesting with Staphylococcus aureus endocarditis: a case report.

Kumar Anirudh A Shah Nishant P NP Menon Venu V Nissen Steven E SE

European heart journal. Case reports 20190601 2

<h4>Background</h4>Purpura fulminans (PF) is a haematologic emergency that can occur in the setting of severe septic shock. Its pathophysiology is not well-understood; however, some evidence suggests it may be mediated by excessive protein C consumption.<h4>Case summary</h4>In this case report, we describe a patient with PF secondary to methicillin-resistant Staphylococcus aureus endocarditis. She presented with severe septic shock and, despite haemodynamic improvement, developed a significant p ...[more]

PMID: 31449632

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Project description:Introduction Purpura fulminans is an acute and fatal condition presenting with acute progressive hemorrhagic infarction of the skin and disseminated intravascular coagulation. Scrub typhus, is an emerging disease of Nepal, despite being a rickettsioses has been rarely associated with Purpura fulminans. The non-specific clinical presentation and limited diagnostic facility make it difficult for clinicians to diagnose the disease. Knowing the prevalence of the disease, suspecting the disease early and treatment with appropriate antibiotics can limit the course of the disease. Case presentation A 46-year-old female with no comorbidity presented with febrile illness and generalized weakness in the emergency department. During the course in hospital, she developed purpura followed by painful hemorrhagic bullae in bilateral lower limb with bluish discoloration in bilateral feet. IgM antibodies against the Orientia Tsutsugamushi antigen came out to be positive making diagnosis of purpura fulminans secondary to scrub typhus. She recovered with anti rickettsial therapy. Discussion Purpura fulminans is an emergency condition. Scrub typhus, one of the rare cause, is diagnosed with Rickettsial DNA by PCR or by Indirect Immunofluorescence Assay (IFA) or Indirect Immunoperoxidase Assay (IPA). Medical management includes Doxycycline, fluid therapy, antipyretics and surgical management includes escharotomies and fasciotomies if required. Conclusion We feel that clinicians should be aware of rickettsia as a differential of acute febrile illness, especially when the patient presents from endemic areas. In addition to it, they should be aware of rare presentations such as purpura fulminans which can help with early suspicion of the disease and appropriate antibiotic therapy. Highlights • Purpura fulminans is an acute condition with skin changes and disseminated intravascular coagulation.• Rarely, acute infectious purpura fulminans, can be caused by Orientia Tsutsugamushi, a common rickettsioses of Nepal.• Clinical suspicion of the disease with appropriate antibiotic therapy can limit the disease course or prevent complication.

Dataset Information

Purpura fulminans manifesting with Staphylococcus aureus endocarditis: a case report.

Background

Case summary

Discussion

Publications

Purpura fulminans manifesting with Staphylococcus aureus endocarditis: a case report.

Similar Datasets

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