Meningococcemia

February 1, 2002
David L. Kaplan, MD

A 49-year-old woman was admitted tothe hospital with a high fever ofabrupt onset, rigor, headache, myalgias,and profound prostration. Hertemperature was 41ºC (105.8ºF);blood pressure, 60/40 mm Hg; respirationrate, 30 breaths per minute;and pulse rate, 130 beats per minute.

A 49-year-old woman was admitted tothe hospital with a high fever ofabrupt onset, rigor, headache, myalgias,and profound prostration. Hertemperature was 41C (105.8F);blood pressure, 60/40 mm Hg; respirationrate, 30 breaths per minute;and pulse rate, 130 beats per minute.Extensive purpuric patches andlarge ecchymoses were noted on thelower extremities and the buttocks.Signs of meningeal irritation wereabsent. Analysis of a specimen of cerebrospinal fluid wasunremarkable; blood cultures revealed an infection causedby Neisseria meningitidis.s patient was given ceftriaxone,2 g bid, and penicillin, 24 million U/d; she was dischargedfrom the hospital after 10 days.Patients with meningococcemia may not demonstratemeningeal signs; however, 50% to 80% will present withpetechiae and purpuric skin lesions.1 Thus, a careful examinationof the skin and mucosal surfaces is warrantedin the acutely ill febrile patient.

References:

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.)