Fig. 1

Summary of the patient’s clinico-biological course. At admission (D1), the patient presented diffuse purpuric lesions (photo, left) that, upon pathological analysis (upper panels), showed thrombosis of nearly all dermal capillaries (left; fibrin is stained pink with hematoxylin–phloxine–saffron stain [arrows]; × 100) as well as several deep dermal arterioles (middle [arrow]; × 200), and the presence of cocci inside the thrombi (right [arrows]; × 800). Analyses of DIC (prothrombin time [PT]), activated partial thromboplastin time (aPTT), fibrinogen and platelets are shown in the table (blue columns indicate care in the ICU; green columns indicate care in the infectious diseases department). The patient presented distal digital ischemia, which was treated from D3 to D11 with Iloprost with a favourable local outcome; final necrosis being limited to the second fingertip (sequential photos of fingers). Upon admission, septic shock was treated with norepinephrine infusion (Norepi.). On D2, the patient presented an acute myocarditis with a hypersensitive troponin Ic peak (red graph) of around 390-fold the reference value and an elevation of the ST segment in the infero-lateral area beginning at D2.5 (captures of the V5 lead on the ECG), requiring dobutamine infusion (Dobu.) for 3 days, with a favourable outcome; troponin Ic concentration returned to normal on D9. The septic shock was complicated by multiple organ failure (see creatinine and lactate values in the table) and systemic biological inflammatory syndrome (lower graph) with an early dramatic increase of blood procalcitonin > 1000-fold the reference value (PCT, red curve, right axis) and a delayed 60-fold increase of C-reactive protein (CRP, purple curve, left axis). Concomitantly, blood concentrations of interleukin-1β (IL-1β, blue curve, left axis), IL-8 (orange curve, left axis) and IL-6 (green curve, right axis) were hugely increased at D1. They returned to normal upon treatment with cefotaxime from D1 to D7, as indicated