Rare presentation of rickettsial infection as purpura fulminans: a case report

• Published in: Journal of medical case reports 2018-05, Vol.12 (1), p.145-145, Article 145
• Main Authors: Dalugama, Chamara, Gawarammana, Indika Bandara
• Format: Article
• Language: English
• Subjects: Anemia; Anti-Bacterial Agents - therapeutic use; Arachnids; Blood platelets; Blood tests; Boutonneuse Fever - complications; Boutonneuse Fever - diagnosis; Boutonneuse Fever - drug therapy; Case Report; Case reports; Chloramphenicol - therapeutic use; Diagnosis; Diagnosis, Differential; Disseminated intravascular coagulation; Female; Fever; Gangrene; Hemorrhage; Humans; Middle Aged; Pathogenesis; Proteins; Purpura fulminans; Purpura Fulminans - diagnosis; Purpura Fulminans - microbiology; Rickettsiae; Rickettsial diseases; Streptococcus infections; Thrombosis; Typhus
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-018-1672-5

Purpura fulminans is an acute life-threatening disorder characterized by intravascular thrombosis and hemorrhagic infarction of the skin complicated with disseminated intravascular coagulation. It is commonly seen in acute infections following meningococcal and streptococcal infections. Few cases of purpura fulminans following rickettsial infections have been described in the literature. We report a case of a 55-year-old Sri Lankan woman who presented to Teaching Hospital Peradeniya with a febrile illness, headache, and myalgia that progressed to an erythematous rash starting over the bilateral lover limbs and hands and that became black and necrotic with a few hemorrhagic blebs. She had normocytic anemia, platelet clumps, and monocytosis as well as a deranged clotting profile. The result of immunofluorescence antibody testing for rickettsial immunoglobulin G was strongly positive for Rickettsia conorii with a rise in titer convalescent sera, and a diagnosis of purpura fulminans following rickettsial infection was made. The patient made an excellent recovery with chloramphenicol treatment. The treating physician should consider the rare but very treatable condition of rickettsial infection as a differential diagnosis in the etiological diagnostic workup of patients presenting with severe purpuric and hemorrhagic rash with fever.