Sudden Fulminant Hyperfibrinolytic Coagulopathyin a Previously Healthy Adult with Brevundimonas Diminuta Bacteremia:

A Case Report and Literature Review

Abstract

Background: Purpura fulminans is a fulminant debilitating disorder with a high mortality rate; its characteristicsinclude disseminated intravascular coagulation, thrombosis, tissue necrosis, cardiovascular collapse, and multipleorgan failure. The most frequent causative pathogens are gram-negative bacteria whose pathogeneses are relatedto endotoxin secretion. Brevundimonas diminuta (B. diminuta) is a ubiquitous aerobic, gram-negative, rod bacterium that causes opportunistic infections, mostly in immunocompromised patients. Although B. diminuta supposedly has low virulence, the clinical features of its infection are unclear due to the limited number of publishedreports.Case presentation: A 30-year-old, previously healthy male presented to the emergency department several hoursafter developing fever, joint pain, and upper abdominal pain. The patient was in shock; his condition rapidly deteriorated, and he subsequently developed skin purpura, hyperfibrinolytic coagulation abnormalities, disturbed consciousness, and multiple organ failure, including acute renal failure. Severe hypercytokinemia and endotoxemiawere observed. Despite intensive care, the patient died 21 hours after hospitalization. B. diminuta was isolatedfrom blood cultures collected prior to antibiotic administration.Conclusion: We describe a fulminant case of hyperfibrinolytic coagulopathy in a previously healthy adult.Although rare, B. diminuta was isolated from blood cultures, and its relationship with purpura fulminans shouldbe considered in this case.