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Τετάρτη 17 Οκτωβρίου 2018

Meningococcemia: rare but life-threatening

Description 

A previously healthy 5-month old girl, presented at the emergency department with high fever (40°C), vomiting and nasal congestion. She had no abnormalities on physical exam and was discharged home with diagnosis of a probable viral infection, after excluding urinary infection.

Ten hours later, the infant was readmitted with purpuric lesions and prostration (figure 1), rapidly presenting with labial cyanosis, capillary refill of 6 s, tachycardia, hypotension and anuria (cold shock). The patient was empirically treated with ceftriaxone and vancomycin, started inotropic and ventilator support, having been transferred to a hospital with a paediatric intensive care unit with a refractory shock, purpuric rash and disseminated intravascular coagulation (figure 2).

Figure 1

Petechiae and purpuric lesions only on the thoracoabdominal region.

Figure 2

Purpura fulminans with necrosis of extremities.

Blood workout revealed leucopenia (2.600/mm3) with neutropenia (2.00/mm3),...



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