Acral Purpura Fulminans With Erythrocyte-Associated Streptococcus pneumoniae: A Case Report
A patient presented with acral purpura fulminans caused by Streptococcus pneumoniae septicemia. With antibiotics and intensive care, he survived but required amputations of both hands and feet due to ischemic necrosis. We observed diplococci adherent to erythrocytes on blood smear. This previously d...
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| Language: | English |
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American College of Physicians
2025-02-01
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| Series: | Annals of Internal Medicine: Clinical Cases |
| Online Access: | https://www.acpjournals.org/doi/10.7326/aimcc.2024.0854 |
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| author | Donald L. Granger Jeannine Pembroke Todd R. Gordon |
| author_facet | Donald L. Granger Jeannine Pembroke Todd R. Gordon |
| author_sort | Donald L. Granger |
| collection | DOAJ |
| description | A patient presented with acral purpura fulminans caused by Streptococcus pneumoniae septicemia. With antibiotics and intensive care, he survived but required amputations of both hands and feet due to ischemic necrosis. We observed diplococci adherent to erythrocytes on blood smear. This previously described phenomenon, named immune adherence, requires complement. Opsonized pneumococci bind to complement receptors on human erythrocytes. Circulating immune adherent pneumococci are delivered by erythrocytes to fixed splenic macrophages for bacterial killing. We hypothesize that defective reticuloendothelial function most likely contributed to our patient's overwhelming infection with septic syndrome, disseminated intravascular coagulation, and acral purpura fulminans. |
| format | Article |
| id | doaj-art-4b6bca6b2c99487c96799f6d3bc27a8a |
| institution | DOAJ |
| issn | 2767-7664 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | American College of Physicians |
| record_format | Article |
| series | Annals of Internal Medicine: Clinical Cases |
| spelling | doaj-art-4b6bca6b2c99487c96799f6d3bc27a8a2025-08-20T03:18:48ZengAmerican College of PhysiciansAnnals of Internal Medicine: Clinical Cases2767-76642025-02-014210.7326/aimcc.2024.0854Acral Purpura Fulminans With Erythrocyte-Associated Streptococcus pneumoniae: A Case ReportDonald L. Granger0Jeannine Pembroke1Todd R. Gordon21Division of Infectious Diseases, Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah2Clinical Laboratory, Microbiology Section, Fort Harrison Veterans Affairs Medical Center, Fort Harrison, Montana3Medical Service, Fort Harrison Veterans Affairs Medical Center, Fort Harrison, MontanaA patient presented with acral purpura fulminans caused by Streptococcus pneumoniae septicemia. With antibiotics and intensive care, he survived but required amputations of both hands and feet due to ischemic necrosis. We observed diplococci adherent to erythrocytes on blood smear. This previously described phenomenon, named immune adherence, requires complement. Opsonized pneumococci bind to complement receptors on human erythrocytes. Circulating immune adherent pneumococci are delivered by erythrocytes to fixed splenic macrophages for bacterial killing. We hypothesize that defective reticuloendothelial function most likely contributed to our patient's overwhelming infection with septic syndrome, disseminated intravascular coagulation, and acral purpura fulminans.https://www.acpjournals.org/doi/10.7326/aimcc.2024.0854 |
| spellingShingle | Donald L. Granger Jeannine Pembroke Todd R. Gordon Acral Purpura Fulminans With Erythrocyte-Associated Streptococcus pneumoniae: A Case Report Annals of Internal Medicine: Clinical Cases |
| title | Acral Purpura Fulminans With Erythrocyte-Associated Streptococcus pneumoniae: A Case Report |
| title_full | Acral Purpura Fulminans With Erythrocyte-Associated Streptococcus pneumoniae: A Case Report |
| title_fullStr | Acral Purpura Fulminans With Erythrocyte-Associated Streptococcus pneumoniae: A Case Report |
| title_full_unstemmed | Acral Purpura Fulminans With Erythrocyte-Associated Streptococcus pneumoniae: A Case Report |
| title_short | Acral Purpura Fulminans With Erythrocyte-Associated Streptococcus pneumoniae: A Case Report |
| title_sort | acral purpura fulminans with erythrocyte associated streptococcus pneumoniae a case report |
| url | https://www.acpjournals.org/doi/10.7326/aimcc.2024.0854 |
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