Staphylococcal Purpura Fulminans
Hedieh Honarpisheh1, Jaroslaw Jedrych1, Mohammad Samim3, Rossitza Lazova11,2, Robert Camp1
Departments of 1Pathology , 2Dermatology and 3Radiology, Yale School of Medicine, New Haven, CT, USA
ABSTRACT
Purpura fulminans (PF) is associated with several infections; however, there are few reports of this entity in association with TSST-1 producing S. aureus. We report a 53-year-old male who presented with fever, progressive hemodynamic instability, multi-organ failure, and thrombocytopenia following lobectomy for a solitary lung metastasis of rectal adenocarcinoma. Additionally, he developed progressive generalized eruption of non-blanching purple to black macules, papules, and plaques on the trunk and extremities consistent with PF. He expired on post-admission day three. Autopsy examination revealed pleural purulent exudate, which grew toxic shock syndrome toxin-1 (TSST-1) producing Staphylococcus aureus. Pre-mortem and autopsy skin biopsies demonstrated subepidermal bullae, epidermal necrosis, and fibrin deposition within small cutaneous vessels with minimal lymphocytic infiltration. Vasculitis was not present. TSS asso-ciated PF may be highly under-recognized and much more com-mon than reflected by the literature.
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