Contou D, Coudroy R, Colin G, et al. - In view of the observation that overwhelming postsplenectomy infections are mainly correlated with pneumococcal infections and almost 20% of patients with overwhelming postsplenectomy infection could develop purpura fulminans, researchers investigated how asplenia/hyposplenia affects the clinical features and the outcomes of adult patients admitted to the ICU for pneumococcal purpura fulminans. In this 17-year national multicenter retrospective cohort study, they assessed 306 adult patients who were admitted to 55 French ICUs for an infectious purpura fulminans from 2000 to 2016. A pneumococcal purpura fulminans was identified in 67/306 patients (22%); of whom, 34 (51%) had asplenia (n = 29/34, 85%) or hyposplenia (n = 5/34, 15%) and 33 (49%) had eusplenia. The analysis revealed the occurrence of half of pneumococcal purpura fulminans episodes in asplenic or hyposplenic patients. One-third of asplenic/hyposplenic patients reported receipt of pneumococcal vaccine. The occurrence of half of pneumococcal purpura fulminans episodes was reported more than 20 years after splenectomy. Patients with or without asplenia or hyposplenia exhibit no significant differences in outcomes of pneumococcal purpura fulminans.