Pneumococcal Sepsis in a Patient with Asplenia and Hypogammaglobulinemia
Samuel J. Starke, MD and Ira Miller, MD
Samuel J. Starke, MD and Ira Miller, MD
New England Journal of Medicine
Oct 16, 2025
1 min read
Samuel J. Starke, MD and Ira Miller, MD
Samuel J. Starke, MD and Ira Miller, MD
New England Journal of Medicine
October 16, 2025
1 min read
Samuel J. Starke, MD and Ira Miller, MD
Samuel J. Starke, MD and Ira Miller, MD
New England Journal of Medicine
October 16, 2025
1 min read
Topics
In this Image in Clinical Medicine from the New England Journal of Medicine, purpura fulminans of the nose and fingers is observed in a man with a history of splenectomy and hypogammaglobulinemia admitted with septic shock.
The authors describe a man with purpura fulminans, a rare life-threatening thrombotic disorder characterized by progressive skin necrosis and disseminated intravascular coagulation. Causes include malignancy, trauma, obstetric complications, and protein C deficiency, but it is most often due to sepsis, like this patient with severe pneumococcal infection. The patient’s deficiency in immunoglobulin production likely diminished his response to the recent vaccination, allowing bacterial dissemination to remain unchecked. Seeing diplococci in a neutrophil, let alone in 20% of them, is never a good sign.
Comment
The authors describe a man with purpura fulminans, a rare life-threatening thrombotic disorder characterized by progressive skin necrosis and disseminated intravascular coagulation. Causes include malignancy, trauma, obstetric complications, and protein C deficiency, but it is most often due to sepsis, like this patient with severe pneumococcal infection. The patient’s deficiency in immunoglobulin production likely diminished his response to the recent vaccination, allowing bacterial dissemination to remain unchecked. Seeing diplococci in a neutrophil, let alone in 20% of them, is never a good sign.