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Case Reports
. 2025 May 12;19(1):216.
doi: 10.1186/s13256-025-05160-y.

Acute infectious purpura fulminant due to Enterococcus faecium infection: a case report

Raghad G Tanbour  1 , Riad Amer  2 , Abdelrahman N Matar  3 , Banan M Aiesh  4
Affiliations
Case Reports

Acute infectious purpura fulminant due to Enterococcus faecium infection: a case report

Raghad G Tanbour et al. J Med Case Rep. .

Abstract

Background: Purpura fulminant is a rare life-threatening disorder characterized by a dysregulated response that is often associated with poor prognosis and lethal outcomes. It is often associated with disseminated intravascular coagulation, skin necrosis, and protein C deficiency leading to thrombotic occlusion of skin arterioles, causing palpable purpuric lesions, spreading ecchymosis, and gangrene, along with hypotension and fever. Purpura fulminant is classified into three distinct categories according to the trigger mechanisms, including neonatal, idiopathic, and acute infectious. Acute infectious purpura fulminant is the most common manifestation, which occurs after bacterial infections caused by acquired protein C deficiency. Although traditionally occurring in Neisseria meningitidis infection and Streptococcus infection, acquired protein C deficiency causing purpura fulminant due to Enterococcus faecium has not been described in the literature. This case report highlights the fact that purpura fulminans can also be a rare presentation of Entercoccus faecium infection.

Case presentation: A 61-year-old Arab man who is immunocompetent presented with sepsis, which later escalated into septic shock due to Enterococcus faecium bacteremia. The patient's hospitalization rapidly developed into multiorgan dysfunction, disseminated intravascular coagulation, and purpura fulminans. Aggressive interventions were initiated, involving the administration of broad-spectrum antibiotics, multiple vasopressors, and mechanical ventilation. Despite these intensive measures, the patient ultimately succumbed to the complications of multiorgan failure and death.

Conclusion: This case illustrates the devastating outcomes that can present from purpura fulminant. However, physicians should consider purpura fulminant caused by Enterococcus faecium infection in the workup of patients presenting with purpuric rash and fever.

Keywords: Enterococcus faecium; Acute infectious purpura fulminant; Disseminated intravascular coagulation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Painful, purple, non-blanching, confluent purpura on the cheeks and nose on day 1
Fig. 2
Fig. 2
Ecchymosis and purpuric lesions on the lower limb
See this image and copyright information in PMC

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