{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T10:37:33Z","timestamp":1769510253214,"version":"3.49.0"},"reference-count":10,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T00:00:00Z","timestamp":1652918400000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,5,5]]},"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:p>Invasive pneumococcal disease occurs in high-risk patient population which includes patients with asplenia and primary hypocomplementaemia. Pneumococcal sepsis can rarely cause disseminated intravascular coagulation (DIC) and intravascular thrombosis of small and medium sized vessels called purpura fulminans which is associated with a high mortality rate. We present the case of an immunocompetent woman in her 50s with an intact spleen who presented with septic shock from <jats:italic>Streptococcus pneumoniae<\/jats:italic> bacteraemia. Her hospital course rapidly progressed to multiorgan dysfunction, DIC and purpura fulminans. She was treated aggressively with broad spectrum antibiotics, coagulation factor replacement, multiple vasopressor support, renal replacement therapy and mechanical ventilator support. Despite aggressive measures, she succumbed to the multiorgan failure.<\/jats:p>","DOI":"10.1136\/bcr-2022-249514","type":"journal-article","created":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T11:50:55Z","timestamp":1652961055000},"page":"e249514","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Purpura fulminans due to <i>Streptococcus pneumoniae<\/i> bacteraemia in an unsplectomised immunocompetent adult without primary hypocomplementaemia"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7219-6327","authenticated-orcid":false,"given":"Swaminathan","family":"Perinkulam Sathyanarayanan","sequence":"first","affiliation":[{"name":"Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA"},{"name":"Department of Internal Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Hericks","sequence":"additional","affiliation":[{"name":"Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA"},{"name":"Division of Pulmonary Critical Care, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,5,19]]},"reference":[{"key":"2025082703135066000_15.5.e249514.1","doi-asserted-by":"publisher","DOI":"10.1615\/JEnvironPatholToxicolOncol.v27.i3.30"},{"key":"2025082703135066000_15.5.e249514.2","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2010.199919"},{"key":"2025082703135066000_15.5.e249514.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2017.10.001"},{"key":"2025082703135066000_15.5.e249514.4","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-200612000-00006"},{"key":"2025082703135066000_15.5.e249514.5","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1186\/s13054-021-03812-1","article-title":"Clinical phenotype and outcomes of pneumococcal versus meningococcal purpura fulminans: a multicenter retrospective cohort study","volume":"25","author":"Contou","year":"2021","journal-title":"Crit Care"},{"key":"2025082703135066000_15.5.e249514.6","unstructured":"Gierke R , McGee L , Beall B . Chapter 11: Pneumococcal. Available: https:\/\/www.cdc.gov\/vaccines\/pubs\/surv-manual\/chpt11-pneumo.html#f3"},{"key":"2025082703135066000_15.5.e249514.7","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1111\/1469-0691.12461","article-title":"Pneumococcal infection in adults: burden of disease","volume":"20 Suppl 5","author":"Drijkoningen","year":"2014","journal-title":"Clin Microbiol Infect"},{"key":"2025082703135066000_15.5.e249514.8","doi-asserted-by":"publisher","DOI":"10.1381\/096089204323093507"},{"key":"2025082703135066000_15.5.e249514.9","doi-asserted-by":"crossref","DOI":"10.12659\/AJCR.923266","article-title":"Septic shock and purpura fulminans due to Streptococcus pneumoniae bacteremia in an unvaccinated immunocompetent adult: case report and review","volume":"21","author":"Djurdjevic","year":"2020","journal-title":"Am J Case Rep"},{"key":"2025082703135066000_15.5.e249514.10","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201511-778FR"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-249514","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:14:00Z","timestamp":1756289640000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-249514"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5]]},"references-count":10,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5,19]]},"published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1136\/bcr-2022-249514"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-249514","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5]]}}}