Purpura Fulminans and Pasteurella Multocida Infection in an Adult: A Case Report

Abstract

Introduction: Purpura fulminans (PF) is a rare rapidly progressive disease caused by microvascular thrombosis of skin vessels manifested as characteristic skin lesions. Three different subtypes have been described: neonatal, idiopathic and acute infectious. Treatment depends on subtype and may include antibiotic therapy, supportive treatment and transfusions (mainly fresh frozen plasma (FFP)). Case presentation: A fifty nine-year-old female presented at emergency department with nausea, vomit, diarrhea and abdominal pain. She was hypotensive, tachycardic, jaundiced and had mild epigastric tenderness. Analysis revealed pancytopenia, coagulopathy, renal failure and hyperbilirubinemia. Arterial blood gas analyses showed compensated metabolic acidosis and hyperlactacidemia. Patient was started on vasopressor therapy for hypotension unresponsive to fluids. Nevertheless, her condition deteriorated and severe metabolic acidosis developed. A purpuric rash developed initially at left thigh and spread through abdomen and thorax. Patient was transferred to an intensive care unit after resuscitation from a cardiorespiratory arrest. Large spectrum antibiotic therapy and renal replacement technique were started as well as transfusion with platelets, FFP and red blood cells. Susceptible Pasteurella multocida was present in two hemocultures. Despite maximal supportive treatment patient's condition deteriorated and dyed 72 hours after admission. Discussion: We described a case of severe acute infectious PF presenting in an adult with Pasteurella multocida bacteriemia. The uniqueness of this case report lye on the rarity of PF in adults and on being to our knowledge the first case described of PF caused by Pasteurella multocida infection.