case_images: PMC11002164_01
case_images: Results of physical examination, microbiological, imaging, and pathological analyses. (A,B) Circular skin wounds with diameters ranging from 1 cm to 5 cm, coated with white scabs. (C) Ultrasonic cardiogram showing an enlarged left ventricle with a diastolic diameter of 59 mm on Day 2. (D,E) Purple pigment secreted by C. violaceum cultured on MacConkey and common nutrition agar. (F,G) Symmetric purpura on the buttocks and scrotum. (H) Purpura fulminans presented with symmetric converged ecchymosis, skin necrosis, and scattered blisters, and with toes progressing to symmetrical peripheral gangrene. In addition, ulcers were present in the center of trauma wounds. (I) Multiple liver abscesses were detected via computed tomography (arrow). (J) Pathological results (100x) showed microvascular thrombosis (*) and retrogression in the squamous epithelium and vessel walls (arrow). (K) Partial desquamation of necrotic epidermis of the lower limbs, formation of fresh epithelium, and recession of gangrene areas limited to the toes.
case_images: fmed-11-1342706-g001.jpg
case_images: PMC11002164_01_fmed-11-1342706-g001.jpg
case_images: fig1
case_images: The wounds were coated with white scabs of a regular round shape, which were mainly located beneath the right knee and on the right acrotarsium (Figures 1A,B), without significant presentation of cellulitis. A UCG reexamination showed an enlarged left ventricle and lower EF (Figure 1C). Meanwhile, C. violaceum resistant to penicillins, beta-lactamases and carbapenems was identified in his blood sample (Figures 1D,E; Table 2). Physical examination indicated newly emerged scleral icterus and progressive symmetric purpura on the buttocks, scrotum, and lower limbs (Figures 1F,G). In addition, peripheral purpura worsened, especially in the lower limbs, ecchymosis converged, skin necrosis developed, blisters appeared and became confluent, and the toes progressed to symmetrical peripheral gangrene (SPG) (Figure 1H). In addition, the abdominal CT showed multiple liver abscesses (Figure 1I). On Day 12, biopsy was performed on the lower limbs, and pathologic results indicated microvascular thrombosis with retrogression in the squamous epithelium and the vessel walls (Figure 1J). As the necrotic epidermis of the lower limbs was gradually replaced by fresh epithelium, and gangrene was limited to the toes (Figure 1K), the patient was transferred to the general ward on Day 33.
case_images: Timeline of onset, diagnosis, and treatment.
case_images: fmed-11-1342706-g002.jpg
case_images: PMC11002164_01_fmed-11-1342706-g002.jpg
case_images: fig2
case_images: The brief timeline of onset, diagnosis, and treatment is shown in Figure 2.