Two patients with fatal staphylococcal septicemia and meningitis demonstrated pustular purpura upon initial examination. Thrombocytopenia was present in both, as was hematemesis. Although superficially resembling the purpura of meningococcemia or trauma, staphylococcal purpura was diagnosed when puncture of the skin lesions and gram stain of the expressed fluid revealed staphylococci. Appropriate antibiotic therapy thus preceded reports of positive blood cultures by many hours. One patient's serum hemolyzed rabbit red cells in vitro, and cerebral hemorrhage and hemorrhagic infarcts were prominent pathologic findings. These abnormalities are consistent with known effects of staphylococcal products, especially alpha toxin (hemolysin). Though only one of many causes of infective purpura, staphylococcal septicemia with purpura can be diagnosed by needle puncture and gram stain of suspicious lesions in acutely ill toxemic patients. Patients with this form of staphylococcal disease rarely recover.
Plaut ME. Staphylococcal Septicemia and Pustular Purpura: Report of Cases. Arch Dermatol. 1969;99(1):82–85. doi:10.1001/archderm.1969.01610190088017
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