SHM Converge Scientific Abstract ePoster Gallery-An Uncommon Presentation of Purpura Fulminans With Staphylococcus Aureus Endocarditis

Pdf Summary

This case report describes an uncommon presentation of purpura fulminans in a patient with methicillin-sensitive <em>Staphylococcus aureus</em> (MSSA) endocarditis, likely in the setting of intravenous drug use. The patient developed septic shock requiring two vasopressors and intubation for airway protection, along with extensive purpuric skin lesions and hemorrhagic bullae on the upper and lower extremities.

Diagnostic workup revealed evidence of severe infection and disseminated coagulopathy. Blood cultures grew MSSA, lactate was elevated, and INR was mildly prolonged. Additional coagulation studies showed markedly low protein C activity, low antithrombin activity, and elevated factor VIII, consistent with the prothrombotic and consumptive abnormalities seen in purpura fulminans. Cardiac imaging identified a new tricuspid valve vegetation on transthoracic echocardiography and recurrent aortic vegetation on the prosthetic aortic valve by transesophageal echocardiography, confirming infective endocarditis involving multiple valves.

The report emphasizes that purpura fulminans can occur as a rare but life-threatening complication of MSSA bacteremia and endocarditis. Because cases of intravenous drug use–associated endocarditis are increasing, particularly during the opioid epidemic, clinicians should maintain a high index of suspicion when patients present with severe sepsis and rapidly progressive purpuric skin findings. Early recognition is important because prompt treatment may allow initiation of disease-modifying interventions and improve outcomes.

Asset Subtitle

Min Woo Hwang

Meta Tag

Author List Mark Delman, Min Woo Hwang, Vaughan Washco

Category Clinical Vignettes

Concept Purpura Fulminans

Concept Staphylococcus aureus Infective Endocarditis

Concept Purpuric Lesions

Concept Infective Endocarditis

Concept Hemorrhagic bullae

Distinguished Non-Finalist

Presenter Organization Inova Fairfax Hospital

Presenting Author Min Woo Hwang

Track Adult

Keywords

purpura fulminans

MSSA endocarditis

Staphylococcus aureus

septic shock

intravenous drug use

purpuric skin lesions

hemorrhagic bullae

disseminated coagulopathy

protein C deficiency

infective endocarditis

Purpura Fulminans

Staphylococcus aureus Infective Endocarditis

Purpuric Lesions

Infective Endocarditis

Hemorrhagic bullae