PMC9429787_01
Development of purpura fulminans secondary to Streptococcus pneumoniae sepsis 16 h after admission. (A) Non-blanching ecchymosis with several flaccid bullae present on right lower extremity, covered by wound dressing. (B) Non-blanching ecchymosis on left thigh and shin.
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Approximately 16 h after admission, large violaceous non-blanching ecchymoses were present extending from the bilateral proximal thighs to the calves, and several flaccid bullae developed (Fig. 1).
Purpura fulminans progression by 36 h after admission. (A) Confluent dusky violaceous ecchymosis with numerous hemorrhagic bullae on entire right leg, with area of sharp demarcation visible on right knee. (B) Dusky gray-violet ecchymosis with sharp borders and various-sized serous and hemorrhagic bullae on left leg.
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Various-sized bullae up to greater than 10 cm filled with red to black-colored fluid were present (Fig. 2).