Purpura Fulminans in a Patient With Cirrhosis and Methicillin-Sensitive Staphylococcus aureus (MSSA) Bacteremia: Diagnostic Challenges in Coagulopathy.

Disseminated intravascular coagulation (DIC) is a critical complication of systemic illness, and its diagnosis can be especially challenging in patients with cirrhosis, where baseline liver-related coagulopathy may mask the development of superimposed consumptive coagulopathy. In the setting of sepsis and liver dysfunction, DIC may progress to purpura fulminans (PF), a rare, life-threatening condition characterized by dermal necrosis and microvascular thrombosis. We present the case of a 54-year-old man with alcoholic cirrhosis and untreated hepatitis C who developed DIC and PF following methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia and toxic shock syndrome (TSS). Despite treatment with antibiotics, transfusions, intravenous immunoglobulin (IVIG), and hemodialysis, he developed multiorgan failure. This case highlights that in patients with sepsis and cirrhosis, acutely worsening coagulation parameters, falling fibrinogen, and evolving purpuric or necrotic skin lesions should not be attributed to liver disease alone but should instead prompt urgent evaluation for DIC and PF. The early recognition of this distinction is essential to guide timely multidisciplinary intervention in this rare but devastating complication.