Beyond the Rash: The Devastating Course of Meningococcal Purpura Fulminans in an Unvaccinated Young Adult

Abstract

Purpura fulminans (PF) is a life-threatening thrombotic disorder characterized by rapidly progressive cutaneous hemorrhagic necrosis, disseminated intravascular coagulation (DIC), and multi-organ failure. Most commonly associated with meningococcemia, PF requires early recognition for optimal outcomes. This report presents the case of a 26-year-old immunocompetent but unvaccinated male who developed PF secondary to meningococcemia, complicated by refractory septic shock, multi-organ failure, and extensive tissue necrosis. His clinical course underscores the aggressive nature of this condition, the critical need for early recognition, and the importance of primary prevention through meningococcal vaccination. The patient's unvaccinated status highlights persistent gaps in vaccination uptake, particularly among individuals outside of university settings. Co-infection with COVID-19 and underlying alcohol use disorder may have contributed to immune dysregulation and increased disease severity. This case also raises awareness of the potential role of COVID-19 in the pathogenesis of meningococcemia. PF remains a dermatologic and hematologic emergency with high mortality, necessitating rapid diagnosis and a multidisciplinary treatment approach. Strengthening vaccination education and advocacy is essential to reduce the burden of PF and its complications.

Keywords: acute infectious purpura fulminans; alcohol use disorder (aud); covid and purpura fulminans; medical dermatology; meningococcemia; neisseria meningitidis; vaccine preventable diseases.

Figure 1. Diffuse, purpuric rash with violaceous macules and patches in a reticular pattern extending from the trunk outwards to the bilateral upper and lower extremities (hospital Day 1).

Figure 2. (A) Left hand with severe necrosis of the digits and ulcerations and bullae on the dorsal surface with superficial crusting (hospital Day 18); (B) right hand with severe necrosis of digits (hospital Day 19); (C) bilateral feet with necrosis of dorsal surfaces and ulceration to right lateral foot (hospital Day 19).