Thread by @guerreroespejo

A 25-yo woman, cirrhosis due to autoimmune hepatitis, not pneumococcal vaccination: rapidly progressive sepsis with purpura fulminans.

16 h after admission, violaceous non-blanching ecchymoses from proximal thighs to the calves, & flaccid bullae.
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#dermatology #MedEd

36 hours after admission, the skin was dusky & violaceous with sharply demarcated borders, bullae filled with red to black-colored fluid

Blood🧫: pan-susceptible Streptococcus pneumoniae.

PNEUMOCOCCAL PURPURA FULMINANS
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doi.org/10.1016/j.idcr…
#IDtwitter #MedTwitter

She had progressive hypoxia & shock despite maximal ventilator & vasopressor support, & the patient passed away within 48 h of admission.

Autopsy: a cirrhotic liver, diffuse alveolar damage, & five liters of serous fluid in the abdominal compartment.
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#Doctor #resident

Purpura fulminans is a skin disorder with high morbidity and mortality which is characterized by microvascular thrombosis and development of hemorrhagic necrosis.
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#MedStudentTwitter #MedicalStudents

Purpura fulminans can be caused by acute infection, most commonly due to Neisseria meningitidis, followed by Streptococcus pneumoniae.

Reports describe cases of pneumococcal PF in patients with asplenia or hyposplenia, and in otherwise healthy adults
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#microbiology #medicine

Infectious purpura fulminans was shown to be associated with 41 % mortality and high morbidity in those who survived: almost one-third required limb amputation.
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#IDtwitter #MedTwitter

Given her history of autoimmune hepatitis & chronic liver disease, the patient should have received the pneumococcal vaccination.

She had not been vaccinated due to lack of health insurance and limited access to the healthcare system.
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#Doctor #MedStudentTwitter

Patients with asplenia or hyposplenia and who undergo splenectomy are at risk of overwhelming infection and sepsis, particularly due to encapsulated organisms, which are resistant to phagocytosis
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#MedicalStudents #microbiology

This case highlights the importance of pneumococcal vaccination in patients with increased vulnerability to encapsulated organisms
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#resident #medicine
doi.org/10.1016/j.idcr…