Septic shock and purpura fulminans secondary to Streptococcus pneumoniae bacteraemia in an immunocompetent individual.

A woman in her 40s presented to the emergency department with a 3-day history of headache, vomiting and fever. Vital signs on arrival indicated septic shock, including fever of 40°C, tachycardia of 110 beats per minute and hypotension of 78/55 mm Hg. A retiform purpuric rash on her limbs, with mottling of skin on the tips of her nose and ears, developed subsequent to admission. This rash was identified as purpura fulminans in the context of disseminated intravascular coagulopathy. Blood cultures isolated Streptococcus pneumoniae (serotype 22F), confirming invasive pneumococcal disease (IPD) as the cause of her septic shock. A life-threatening clinical course ensued with multiorgan involvement. This case adds to the limited body of literature describing IPD and purpura fulminans in immunocompetent individuals. Similar presentations are associated with a high mortality rate. In this case, the patient survived; however, she had significant sequelae of her infection, requiring a left transmetatarsal amputation.