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Case Reports
. 2021 Feb 9;13(2):e13249.
doi: 10.7759/cureus.13249.

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

Maria Del Mar Morales Hernandez  1 , Michael Carranza  2 , Bijal Patel  2 , Joshua Calvert  2 , Ghania Masri  2
Affiliations
Case Reports

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

Maria Del Mar Morales Hernandez et al. Cureus. .

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.

Keywords: disseminated intravascular coagulation; escherichia coli; purpura fulminans; symmetric peripheral gangrene.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CT of the abdomen and pelvis demonstrating perinephric stranding and extensive pneumoureter with gas extending into the renal collecting system (A), which improved on repeat CT following emergent left ureteral stenting (B).
Figure 2
Figure 2. Acral (A-C) lesions with hemorrhagic necrosis and non-acral (D) retiform purpuric lesions consistent with symmetric peripheral gangrene and purpura fulminans.
Figure 3
Figure 3. CTA of the left upper extremity demonstrating radial artery occlusion (arrow) and patency of the ulnar artery.
Figure 4
Figure 4. Histologic section shows dermal vessels with fibrin thrombi (arrow A) and both epidermal and adnexal necrosis (arrow B) and mild superficial lymphocytic inflammation (arrow C).
See this image and copyright information in PMC

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