73M Hx TTP s/p splenectomy 10yr prior, otherwise healthy p/w worsening malaise, fevers, chills x24hr. PE wnl. Labs sig for mildly elevated lactate. Pt held for fluids & obs.
In 6hrs, thrombocytopenic, coagulopathic, rising lactate with pH 7.1 & rapidly developing retiform rash.
73M Hx TTP s/p splenectomy 10yr prior, otherwise healthy p/w worsening malaise, fevers, chills x24hr. PE wnl. Labs sig for mildly elevated lactate. Pt held for fluids & obs. In 6hrs, thrombocytopenic, coagulopathic, rising lactate with pH 7.1 & rapidly developing retiform rash.
73M Hx TTP s/p splenectomy 10yr prior, otherwise healthy p/w worsening malaise, fevers, chills x24hr. PE wnl. Labs sig for mildly elevated lactate. Pt held for fluids & obs. In 6hrs, thrombocytopenic, coagulopathic, rising lactate with pH 7.1 & rapidly developing retiform rash.
73M Hx TTP s/p splenectomy 10yr prior, otherwise healthy p/w worsening malaise, fevers, chills x24hr. PE wnl. Labs sig for mildly elevated lactate. Pt held for fluids & obs. In 6hrs, thrombocytopenic, coagulopathic, rising lactate with pH 7.1 & rapidly developing retiform rash.
Purpura fulminans w/ infectious etiology favored. Blood Cx pending & pt started on broad-spectrum abx. ID requesting prelim on peripheral smear. Slides stained with Wright-Giemsa and (inlay) dilute Giemsa.
Thoughts?
Blood Cx positive at 24hrs.
Gram stain showing thin, spindled, GNRs.
Plated, green on chocolate and pitting agar, negative on MacConkey at 48hrs.
Gliding-motility, indole & oxidase-negative.
Diagnosis? A very interesting day on call @BIDMCpath!
MALDI-TOF & 16S rRNA confirmed Capnocytophaga canimorsus, an oral commensal in dogs & cats.
So, sepsis eventuating in purpura fulminans in asplenic pts is frequently caused by capsule-bearing bacteria, esp Neisseria/Streptococcus, but remember to include C. canimorsus in the Ddx!
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