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A 49-year-old woman was admitted to the hospital with a high fever of abrupt onset, rigor, headache, myalgias, and profound prostration. Her temperature was 41C (105.8F); blood pressure, 60/40 mm Hg; respiration rate, 30 breaths per minute; and pulse rate, 130 beats per minute. Extensive purpuric patches and large ecchymoses were noted on the lower extremities and the buttocks. Signs of meningeal irritation were absent. Analysis of a specimen of cerebrospinal fluid was unremarkable; blood cultures revealed an infection caused by Neisseria meningitidis.s patient was given ceftriaxone, 2 g bid, and penicillin, 24 million U/d; she was discharged from the hospital after 10 days. Patients with meningococcemia may not demonstrate meningeal signs; however, 50% to 80% will present with petechiae and purpuric skin lesions.1 Thus, a careful examination of the skin and mucosal surfaces is warranted in the acutely ill febrile patient.


REFERENCE: 1. Rosenstein NE, Perkins BA, Stephens DS, et al. Meningococcal disease. N Engl J Med. 2001;344:1378-1388. (Case and photograph courtesy of Drs Evagelos Liberopoulos, Dimitris Christidis, and Moses Elisaf.)
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