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.
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.)