Early recognition and multidisciplinary care in a pediatric patient with acute infectious purpura fulminans due to MRSA: A rare case report

Acute infectious purpura fulminans (PF) is a rare but life-threatening condition characterized by rapidly progressive purpura, skin necrosis, and disseminated intravascular coagulation. We present a case of a 4-year-old male child who presented with a high-grade fever, maculopapular rash, encephalopathy, and gangrene of distal digits of hands and feet. The child had a tender right submandibular swelling and hepatomegaly. Laboratory findings included leukocytosis (26.48 × 10^9/L), thrombocytopenia (28,000/µL), an elevated C-reactive protein (296 mg/L), and coagulopathy (INR 1.84, D-dimer 540 ng/mL). Imaging revealed submandibular abscess and an extensive infiltrates in the right lower lobe of the lung. Blood culture and pus culture from neck swelling yielded methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infection. The child was treated with intravenous vancomycin (15 mg/kg every 6 h) and linezolid (10 mg/kg every 8 h) for 4 weeks, heparin infusion (20 units/kg/hour), and supportive management, followed by oral rivaroxaban (1 mg/kg twice daily) for the next 6 months. Plastic surgery was consulted for gangrene. This case highlights the importance of early recognition, targeted antimicrobial therapy, and multidisciplinary management of PF secondary to MRSA infection in children.