Purpura Fulminans in an Immunocompromised Patient with Invasive Pneumococcal Disease: A Case Report

Paulo Fernandes; Ana Carina Baldino; Sara Carvalho; João Maia Oliveira; José Vaz

doi:doi:10.11648/j.ijmcr.20250404.12

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Purpura Fulminans in an Immunocompromised Patient with Invasive Pneumococcal Disease: A Case Report

Paulo Fernandes^*

, Ana Carina Baldino, Sara Carvalho, João Maia Oliveira, José Vaz

Published in International Journal of Medical Case Reports (Volume 4, Issue 4)

Received: 1 October 2025 Accepted: 14 October 2025 Published: 30 October 2025

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Abstract

Background: Streptococcus pneumoniae is a leading cause of community-acquired pneumonia and invasive pneumococcal disease, particularly in patients with impaired immune function or asplenia. Pneumococcal infections remain associated with high morbidity and mortality, especially when complicated by septic shock and multiple organ failure. Purpura fulminans is a rare but catastrophic dermatologic and hematologic manifestation characterized by rapidly evolving purpuric skin lesions with central necrosis, reflecting underlying systemic coagulopathy. Case presentation: We report the case of a 41-year-old man with antisynthetase syndrome and a history of splenic infarction, who was receiving immunosuppressive therapy. He presented with septic shock, respiratory failure with lung infiltrates, and diffuse violaceous skin lesions. Laboratory findings revealed severe disseminated intravascular coagulation, and Streptococcus pneumoniae bacteremia was confirmed by polymerase chain reaction. Despite the immediate initiation of broad-spectrum antibiotics and intensive care admission for supportive care, his condition deteriorated rapidly, developing refractory multiorgan failure, and death occurred within 12 hours of hospital admission. Conclusions: This case highlights the fulminant and often fatal course of pneumococcal sepsis in high-risk patients. The immunosuppressive therapy and functional asplenia likely contributed to impaired bacterial clearance and overwhelming infection. While empiric antibiotic coverage was appropriate, the rapid clinical decline demonstrates the lethal synergy between severe bacterial sepsis and purpura fulminans associated consumptive coagulopathy. Preventive strategies, particularly pneumococcal vaccination, remain central to reducing the burden of invasive pneumococcal disease in immunocompromised and asplenic individuals.

Published in	International Journal of Medical Case Reports (Volume 4, Issue 4)
DOI	10.11648/j.ijmcr.20250404.12
Page(s)	63-67
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Invasive Pneumococcal Disease, Purpura Fulminans, Disseminated Intravascular Coagulation, Septic Shock

References

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[2]	Said, M. A., Johnson, H. L., Nonyane, B. A., Deloria-Knoll, M., O'Brien, K. L., AGEDD Adult Pneumococcal Burden Study Team, Andreo, F., Beovic, B., Blanco, S., Boersma, W. G., Boulware, D. R., Butler, J. C., Carratalà, J., Chang, F. Y., Charles, P. G., Diaz, A. A., Domínguez, J., Ehara, N., Endeman, H., Falcó, V.,… Watt, J. P. (2013). Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques. PloS one, 8(4), e60273. https://doi.org/10.1371/journal.pone.0060273
[3]	Djurdjevic, N., Taweesedt, P. T., Paulson, M., LaNou, A., Radovanovic, M., Patel, J. N., Veselinovic, M., McDermott, W. R., & Dumic, I. (2020). Septic Shock and Purpura Fulminans Due to Streptococcus pneumoniae Bacteremia in an Unvaccinated Immunocompetent Adult: Case Report and Review. The American journal of case reports, 21, e923266. https://doi.org/10.12659/AJCR.923266
[4]	Centers for Disease Control and Prevention. (2024, February 6). Clinical features of pneumococcal disease. https://www.cdc.gov/pneumococcal/hcp/clinical-signs/index.html
[5]	Kahraman, H., Yıldız, P., Yılmaz, Ş., & others. (2025). Impact of invasive and noninvasive pneumococcal diseases on adult populations: Risk factors and vaccination status. BMC Infectious Diseases, 25, Article 172. https://doi.org/10.1186/s12879-025-10579-1
[6]	Hamasaki, A., Yumoto, T., Fukushima, S., Hagiya, H., Chang, B., Akeda, Y., Hongo, T., Tsukahara, K., Naito, H., & Nakao, A. (2025). Purpura fulminans caused by Streptococcus pneumoniae serotype 23A in a young post-splenectomy man: A case report. Journal of infection and chemotherapy: official journal of the Japan Society of Chemotherapy, 31(10), 102791. https://doi.org/10.1016/j.jiac.2025.102791
[7]	Perera, T. B., & Murphy-Lavoie, H. M. (2023, July 17). Purpura fulminans. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532865/
[8]	Hale, A. J., LaSalvia, M., Kirby, J. E., Kimball, A., & Baden, R. (2016). Fatal purpura fulminans and Waterhouse-Friderichsen syndrome from fulminant Streptococcus pneumoniae sepsis in an asplenic young adult. IDCases, 6, 1–4. https://doi.org/10.1016/j.idcr.2016.08.004
[9]	Kruckow, K. L., Zhao, K., Bowdish, D. M., & others. (2023). Acute organ injury and long-term sequelae of severe pneumococcal infections. Pneumonia, 15, Article 5. https://doi.org/10.1186/s41479-023-00110-y
[10]	Di Sabatino, A., Carsetti, R., & Corazza, G. R. (2011). Post-splenectomy and hyposplenic states. Lancet (London, England), 378(9785), 86–97. https://doi.org/10.1016/S0140-6736(10)61493-6
[11]	Chalmers, E., Cooper, P., Forman, K., Grimley, C., Khair, K., Minford, A., Morgan, M., & Mumford, A. D. (2011). Purpura fulminans: recognition, diagnosis and management. Archives of disease in childhood, 96(11), 1066–1071. https://doi.org/10.1136/adc.2010.199919
[12]	Martí-Carvajal AJ, Solà I, Gluud C et al: Human recombinant protein C for severe sepsis and septic shock in adult and paediatric patients. Cochrane Database Syst Rev, 2012; 12: CD004388.
[13]	de Kleijn ED, de Groot R, Hack CE et al: Activation of protein C following infusion of protein C concentrate in children with severe meningococcal sepsis and purpura fulminans: A randomized, double-blinded, placebo-controlled, dose-finding study. Crit Care Med, 2003; 31(6): 1839-47.
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APA Style

Fernandes, P., Baldino, A. C., Carvalho, S., Oliveira, J. M., Vaz, J. (2025). Purpura Fulminans in an Immunocompromised Patient with Invasive Pneumococcal Disease: A Case Report. International Journal of Medical Case Reports, 4(4), 63-67. https://doi.org/10.11648/j.ijmcr.20250404.12

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ACS Style

Fernandes, P.; Baldino, A. C.; Carvalho, S.; Oliveira, J. M.; Vaz, J. Purpura Fulminans in an Immunocompromised Patient with Invasive Pneumococcal Disease: A Case Report. Int. J. Med. Case Rep. 2025, 4(4), 63-67. doi: 10.11648/j.ijmcr.20250404.12

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AMA Style

Fernandes P, Baldino AC, Carvalho S, Oliveira JM, Vaz J. Purpura Fulminans in an Immunocompromised Patient with Invasive Pneumococcal Disease: A Case Report. Int J Med Case Rep. 2025;4(4):63-67. doi: 10.11648/j.ijmcr.20250404.12

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@article{10.11648/j.ijmcr.20250404.12,
  author = {Paulo Fernandes and Ana Carina Baldino and Sara Carvalho and João Maia Oliveira and José Vaz},
  title = {Purpura Fulminans in an Immunocompromised Patient with Invasive Pneumococcal Disease: A Case Report
},
  journal = {International Journal of Medical Case Reports},
  volume = {4},
  number = {4},
  pages = {63-67},
  doi = {10.11648/j.ijmcr.20250404.12},
  url = {https://doi.org/10.11648/j.ijmcr.20250404.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmcr.20250404.12},
  abstract = {Background: Streptococcus pneumoniae is a leading cause of community-acquired pneumonia and invasive pneumococcal disease, particularly in patients with impaired immune function or asplenia. Pneumococcal infections remain associated with high morbidity and mortality, especially when complicated by septic shock and multiple organ failure. Purpura fulminans is a rare but catastrophic dermatologic and hematologic manifestation characterized by rapidly evolving purpuric skin lesions with central necrosis, reflecting underlying systemic coagulopathy. Case presentation: We report the case of a 41-year-old man with antisynthetase syndrome and a history of splenic infarction, who was receiving immunosuppressive therapy. He presented with septic shock, respiratory failure with lung infiltrates, and diffuse violaceous skin lesions. Laboratory findings revealed severe disseminated intravascular coagulation, and Streptococcus pneumoniae bacteremia was confirmed by polymerase chain reaction. Despite the immediate initiation of broad-spectrum antibiotics and intensive care admission for supportive care, his condition deteriorated rapidly, developing refractory multiorgan failure, and death occurred within 12 hours of hospital admission. Conclusions: This case highlights the fulminant and often fatal course of pneumococcal sepsis in high-risk patients. The immunosuppressive therapy and functional asplenia likely contributed to impaired bacterial clearance and overwhelming infection. While empiric antibiotic coverage was appropriate, the rapid clinical decline demonstrates the lethal synergy between severe bacterial sepsis and purpura fulminans associated consumptive coagulopathy. Preventive strategies, particularly pneumococcal vaccination, remain central to reducing the burden of invasive pneumococcal disease in immunocompromised and asplenic individuals.
},
 year = {2025}
}

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TY  - JOUR
T1  - Purpura Fulminans in an Immunocompromised Patient with Invasive Pneumococcal Disease: A Case Report

AU  - Paulo Fernandes
AU  - Ana Carina Baldino
AU  - Sara Carvalho
AU  - João Maia Oliveira
AU  - José Vaz
Y1  - 2025/10/30
PY  - 2025
N1  - https://doi.org/10.11648/j.ijmcr.20250404.12
DO  - 10.11648/j.ijmcr.20250404.12
T2  - International Journal of Medical Case Reports
JF  - International Journal of Medical Case Reports
JO  - International Journal of Medical Case Reports
SP  - 63
EP  - 67
PB  - Science Publishing Group
SN  - 2994-7049
UR  - https://doi.org/10.11648/j.ijmcr.20250404.12
AB  - Background: Streptococcus pneumoniae is a leading cause of community-acquired pneumonia and invasive pneumococcal disease, particularly in patients with impaired immune function or asplenia. Pneumococcal infections remain associated with high morbidity and mortality, especially when complicated by septic shock and multiple organ failure. Purpura fulminans is a rare but catastrophic dermatologic and hematologic manifestation characterized by rapidly evolving purpuric skin lesions with central necrosis, reflecting underlying systemic coagulopathy. Case presentation: We report the case of a 41-year-old man with antisynthetase syndrome and a history of splenic infarction, who was receiving immunosuppressive therapy. He presented with septic shock, respiratory failure with lung infiltrates, and diffuse violaceous skin lesions. Laboratory findings revealed severe disseminated intravascular coagulation, and Streptococcus pneumoniae bacteremia was confirmed by polymerase chain reaction. Despite the immediate initiation of broad-spectrum antibiotics and intensive care admission for supportive care, his condition deteriorated rapidly, developing refractory multiorgan failure, and death occurred within 12 hours of hospital admission. Conclusions: This case highlights the fulminant and often fatal course of pneumococcal sepsis in high-risk patients. The immunosuppressive therapy and functional asplenia likely contributed to impaired bacterial clearance and overwhelming infection. While empiric antibiotic coverage was appropriate, the rapid clinical decline demonstrates the lethal synergy between severe bacterial sepsis and purpura fulminans associated consumptive coagulopathy. Preventive strategies, particularly pneumococcal vaccination, remain central to reducing the burden of invasive pneumococcal disease in immunocompromised and asplenic individuals.

VL  - 4
IS  - 4
ER  -

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Author Information

Paulo Fernandes

Intensive Care Unit, Hospital José Joaquim Fernandes, Beja, Portugal

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http://orcid.org/0009-0005-2427-6612
Ana Carina Baldino

Internal Medicine Department, Hospital José Joaquim Fernandes, Beja, Portugal

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Sara Carvalho

Intensive Care Unit, Hospital José Joaquim Fernandes, Beja, Portugal

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João Maia Oliveira

Intensive Care Unit, Hospital José Joaquim Fernandes, Beja, Portugal

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José Vaz

Intensive Care Unit, Hospital José Joaquim Fernandes, Beja, Portugal

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APA Style

Fernandes, P., Baldino, A. C., Carvalho, S., Oliveira, J. M., Vaz, J. (2025). Purpura Fulminans in an Immunocompromised Patient with Invasive Pneumococcal Disease: A Case Report. International Journal of Medical Case Reports, 4(4), 63-67. https://doi.org/10.11648/j.ijmcr.20250404.12

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ACS Style

Fernandes, P.; Baldino, A. C.; Carvalho, S.; Oliveira, J. M.; Vaz, J. Purpura Fulminans in an Immunocompromised Patient with Invasive Pneumococcal Disease: A Case Report. Int. J. Med. Case Rep. 2025, 4(4), 63-67. doi: 10.11648/j.ijmcr.20250404.12

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AMA Style

Fernandes P, Baldino AC, Carvalho S, Oliveira JM, Vaz J. Purpura Fulminans in an Immunocompromised Patient with Invasive Pneumococcal Disease: A Case Report. Int J Med Case Rep. 2025;4(4):63-67. doi: 10.11648/j.ijmcr.20250404.12

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@article{10.11648/j.ijmcr.20250404.12,
  author = {Paulo Fernandes and Ana Carina Baldino and Sara Carvalho and João Maia Oliveira and José Vaz},
  title = {Purpura Fulminans in an Immunocompromised Patient with Invasive Pneumococcal Disease: A Case Report
},
  journal = {International Journal of Medical Case Reports},
  volume = {4},
  number = {4},
  pages = {63-67},
  doi = {10.11648/j.ijmcr.20250404.12},
  url = {https://doi.org/10.11648/j.ijmcr.20250404.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmcr.20250404.12},
  abstract = {Background: Streptococcus pneumoniae is a leading cause of community-acquired pneumonia and invasive pneumococcal disease, particularly in patients with impaired immune function or asplenia. Pneumococcal infections remain associated with high morbidity and mortality, especially when complicated by septic shock and multiple organ failure. Purpura fulminans is a rare but catastrophic dermatologic and hematologic manifestation characterized by rapidly evolving purpuric skin lesions with central necrosis, reflecting underlying systemic coagulopathy. Case presentation: We report the case of a 41-year-old man with antisynthetase syndrome and a history of splenic infarction, who was receiving immunosuppressive therapy. He presented with septic shock, respiratory failure with lung infiltrates, and diffuse violaceous skin lesions. Laboratory findings revealed severe disseminated intravascular coagulation, and Streptococcus pneumoniae bacteremia was confirmed by polymerase chain reaction. Despite the immediate initiation of broad-spectrum antibiotics and intensive care admission for supportive care, his condition deteriorated rapidly, developing refractory multiorgan failure, and death occurred within 12 hours of hospital admission. Conclusions: This case highlights the fulminant and often fatal course of pneumococcal sepsis in high-risk patients. The immunosuppressive therapy and functional asplenia likely contributed to impaired bacterial clearance and overwhelming infection. While empiric antibiotic coverage was appropriate, the rapid clinical decline demonstrates the lethal synergy between severe bacterial sepsis and purpura fulminans associated consumptive coagulopathy. Preventive strategies, particularly pneumococcal vaccination, remain central to reducing the burden of invasive pneumococcal disease in immunocompromised and asplenic individuals.
},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - Purpura Fulminans in an Immunocompromised Patient with Invasive Pneumococcal Disease: A Case Report

AU  - Paulo Fernandes
AU  - Ana Carina Baldino
AU  - Sara Carvalho
AU  - João Maia Oliveira
AU  - José Vaz
Y1  - 2025/10/30
PY  - 2025
N1  - https://doi.org/10.11648/j.ijmcr.20250404.12
DO  - 10.11648/j.ijmcr.20250404.12
T2  - International Journal of Medical Case Reports
JF  - International Journal of Medical Case Reports
JO  - International Journal of Medical Case Reports
SP  - 63
EP  - 67
PB  - Science Publishing Group
SN  - 2994-7049
UR  - https://doi.org/10.11648/j.ijmcr.20250404.12
AB  - Background: Streptococcus pneumoniae is a leading cause of community-acquired pneumonia and invasive pneumococcal disease, particularly in patients with impaired immune function or asplenia. Pneumococcal infections remain associated with high morbidity and mortality, especially when complicated by septic shock and multiple organ failure. Purpura fulminans is a rare but catastrophic dermatologic and hematologic manifestation characterized by rapidly evolving purpuric skin lesions with central necrosis, reflecting underlying systemic coagulopathy. Case presentation: We report the case of a 41-year-old man with antisynthetase syndrome and a history of splenic infarction, who was receiving immunosuppressive therapy. He presented with septic shock, respiratory failure with lung infiltrates, and diffuse violaceous skin lesions. Laboratory findings revealed severe disseminated intravascular coagulation, and Streptococcus pneumoniae bacteremia was confirmed by polymerase chain reaction. Despite the immediate initiation of broad-spectrum antibiotics and intensive care admission for supportive care, his condition deteriorated rapidly, developing refractory multiorgan failure, and death occurred within 12 hours of hospital admission. Conclusions: This case highlights the fulminant and often fatal course of pneumococcal sepsis in high-risk patients. The immunosuppressive therapy and functional asplenia likely contributed to impaired bacterial clearance and overwhelming infection. While empiric antibiotic coverage was appropriate, the rapid clinical decline demonstrates the lethal synergy between severe bacterial sepsis and purpura fulminans associated consumptive coagulopathy. Preventive strategies, particularly pneumococcal vaccination, remain central to reducing the burden of invasive pneumococcal disease in immunocompromised and asplenic individuals.

VL  - 4
IS  - 4
ER  -

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