{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T11:09:40Z","timestamp":1771931380018,"version":"3.50.1"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Purpura fulminans (PF) is a rare, life-threatening emergency characterized by rapidly progressive purpura evolving into hemorrhagic bullae and skin necrosis due to dermal microvascular thrombosis, typically accompanied by shock and disseminated intravascular coagulation (DIC). We report two fatal adult cases of infection-associated PF caused by Streptococcus pyogenes (group A streptococcus). Both patients presented with early gastrointestinal symptoms and rapidly developed septic shock, severe coagulopathy compatible with overt DIC, and extensive lower-limb purpura with bullae and necrosis. Pathogen identification was supported by next-generation sequencing from blood and\/or tissue specimens. Management required immediate resuscitation, organ support, targeted anti\u2013group A streptococcal therapy, and surgical source control; nevertheless, both patients deteriorated with refractory multiorgan failure. These cases highlight that gastrointestinal symptoms may precede fulminant invasive S. pyogenes infection with PF and streptococcal toxic shock syndrome overlap. Early recognition of the clinical pattern (shock + rapidly progressive purpura\/bullae + DIC) and aggressive multidisciplinary management are essential.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1659910","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T11:45:42Z","timestamp":1770723942000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Group A \u03b2-hemolytic streptococcus causing purpura fulminans: two case reports"],"prefix":"10.3389","volume":"17","author":[{"given":"A.","family":"Alkhatatbeh","sequence":"first","affiliation":[{"name":"Department of Orthopedics Surgery, The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiechen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Surgery, The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongru","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Emergency Intensive Care Unit (EICU), The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zebin","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Surgery, The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongjiang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Surgery, The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Surgery, The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongfei","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Surgery, The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xue","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Surgery, The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoqing","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Emergency Intensive Care Unit (EICU), The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuting","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Emergency Intensive Care Unit (EICU), The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Surgery, The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2024025078","article-title":"How I diagnose and treat acute infection\u2013associated purpura 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J"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.5070\/D331365368","article-title":"Purpura fulminans secondary to toxic shock syndrome induced by Group A Streptococcal bacteremia in an adult patient","volume":"31","author":"Hartmann","year":"2025","journal-title":"Dermatol Online J"},{"key":"B9","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.tmrv.2017.10.001","article-title":"Purpura fulminans: mechanism and management of dysregulated hemostasis","volume":"32","author":"Colling","year":"2018","journal-title":"Transfusion Med Rev"},{"key":"B10","doi-asserted-by":"publisher","first-page":"ski2.186","DOI":"10.1002\/ski2.186","article-title":"Klebsiella-induced acute infectious purpura fulminans in a thai woman: case report and review of literature","volume":"3","author":"Temnithikul","year":"2023","journal-title":"Skin Health Dis"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3233\/CH-190588","article-title":"Early fasciotomies and plastic-surgical reconstruction may enhance preservation of functional extremity length in purpura fulminans","volume":"75","author":"Koch","year":"2020","journal-title":"Clin Hemorheol Microcirc"},{"key":"B12","unstructured":"Clinical guidance for streptococcal toxic shock syndrome\n          \n          \n          Atlanta, GA, United States\n          Group A Strep\n          \n          2025"},{"key":"B13","unstructured":"WHO-ICRC Basic Emergency Care: approach to the acutely ill and injured. Manual. 30 October 2018"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1659910\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:21:09Z","timestamp":1771928469000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1659910\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,10]]},"references-count":13,"alternative-id":["10.3389\/fimmu.2026.1659910"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1659910","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,10]]},"article-number":"1659910"}}