Life-threatening Streptococcus suis sepsis presenting with purpura fulminans and toxic shock-like syndrome in a patient with unknown exposure route.
Emiri Muranaka, Mutsuka Kurihara, Yasunori Yoshida et al.
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Case in brief
A 56-year-old man with no clear history of swine contact presented with fever and altered mental status, then rapidly developed septic shock, disseminated intravascular coagulation, and purpura fulminans. Blood cultures grew Streptococcus suis; molecular analysis identified serotype 2, sequence type 1, in clonal complex 1. He survived after intensive multimodal treatment and initial resuscitation, but extensive lower-extremity necrosis ultimately required bilateral below-knee amputation. He was later transferred to a nursing facility.
What made this case unusual
The patient had no identifiable swine exposure despite life-threatening S. suis infection with a toxic shock-like presentation, leaving the route of exposure unknown.
Diagnostic / clinical pearl
Consider S. suis in severe sepsis with purpura fulminans even when a history of pig or pork exposure is absent; blood culture and molecular characterization established the diagnosis in this case.
Why it matters
The case highlights the potential for unrecognized exposure routes and supports clinical awareness and epidemiological surveillance, as noted by the authors.