Disseminated intravascular coagulation in pneumococcemia

Excerpt

A previously healthy 46-year-old woman presented to emergency room with sudden asthenia, fever and diarrhea. Onset of a septic shock with multiple organ failure quickly led to intensive care unit management. On physical examination, she had small purpura lesions on her legs (Fig. 1) and ecchymotic lesions on both facial (Fig. 2) and limb extremities (Fig. 3). There was no meningeal syndrome. Laboratory analyses were notable for disseminated intravascular coagulation with a platelet count of 23,000 per mm³, prolonged prothrombin time, low fibrinogen level (1.5 g per liter), increased d-dimer level (> 20.000 ng per milliliter) and fibrin degradation products (150 μg per milliliter) without schizocytes. Blood cultures grew Streptococcus pneumoniae, confirming the diagnosis of pneumococcemia with disseminated intravascular coagulation. Further investigations with full-body CT scan and immunologic screening did not allow identification of the infectious source nor of the immunocompromised underlying condition. The patient recovered well after an antibiotic course of cefotaxime.

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