Purpuric Eruption: Sign of Infected Bypass Graft.

A 61 year old man presented with fever, malaise and a palpable painless purpuric eruption confined to the left leg and foot (A) Fig. 1. There were no audible heart murmurs or lesions in the left thigh or in the other limbs. The patient had a history of aorto-bi-femoral bypass and a below knee left femoropopliteal bypass. On admission, pulses were normal bilaterally. Laboratory tests demonstrated a leukocytosis and elevated erythrocyte sedimentation rate. Computed tomography scan showed a peri-prosthetic abscess around the left iliac branch and femoropopliteal bypass (B) Fig. 2. An echocardiogram performed pre-operatively showed no signs of endocarditis, namely vegetations or peri-valvular abscesses.

Figure 1

Figure 2

Purpuric skin eruption located distal to a vascular prosthesis is a classic, but sometimes overlooked sign of vascular graft infection.1, 2 However, in a patient with unilateral lesions, a regional cause of septic embolisation should be considered.1, 3 The exclusion of graft infection is mandatory owing to the poor prognosis of this condition.1, 2, 3