# Purpura Fulminans and Septic Shock With Streptococcus pneumoniae Bacteraemia in a Patient With Unacknowledged Functional Hyposplenism

## TL;DR

A patient with undiagnosed functional hyposplenism developed severe purpura fulminans and septic shock from Streptococcus pneumoniae, requiring intensive treatment and amputations.

## Contribution

This case report emphasizes the life-threatening risk of Streptococcus pneumoniae bacteraemia in patients with functional hyposplenism.

## Key findings

- The patient's condition rapidly deteriorated into multiorgan failure and purpura fulminans.
- Early dual antibiotic therapy and supportive care improved survival despite severe complications.
- The case underscores the importance of recognizing functional hyposplenism in sepsis management.

## Abstract

Purpura fulminans is a rare but devastating life-threatening condition characterised by a subtype of disseminated intravascular coagulation with extensive tissue thrombosis and hemorrhagic skin necrosis.

We report the case of a male patient in his 50s, with unacknowledged functional hyposplenism suspected after an abdominal CT scan on admission, who was admitted in septic shock secondary to Streptococcus pneumoniae bacteraemia. The patient’s condition deteriorated rapidly, leading to multiorgan failure, anuric acute kidney injury, disseminated intravascular coagulation with purpura fulminans, and encephalopathy. Management focused on the early initiation of dual antibiotic therapy, fluid resuscitation with crystalloids, hemodynamic support, renal replacement therapy, and mechanical ventilatory support. The patient survived but developed digital and lower limb necrosis, requiring multiple necrosectomies and skin grafts to optimise the outcome of bilateral transtibial amputations.

This case highlights the potential severity of purpura fulminans secondary to Streptococcus pneumoniae bacteraemia in a patient with functional hyposplenism.