PURPURA FULMINANS IN PROGRESS OF ACUTE MENINGOCOCCALSEPSIS IN A 24-YEAR OLD WOMAN, ENDED WITH RECOVERY

Pekova L.*, P. Parousheva and D. Petrov

ABSTRACT

We present a case of acute meningococcal sepsis in a 24-year old female. She presented with a 12 hours history of fever, asthenia, headache and vomiting. Just an hour before the admission a petechial rash on the lower extremities appeared. On admission there was a clinical manifestation of septic shock and cardiovascular collapse - temperature, RR 50/20, heart rate 140-160 per minute, respiratory rate 4 per minute. Her skin was greyish, cyanotic with a typical hemorrhagic-necrotic rash widely distributed over the lower extremities. Enlarged liver and spleen presented. The neurological examination revealed brisk tendon and periosted reflexes and mild signs of meningeal-radicular injury (MRI). Blood tests showed leukocytosis with a left shift, hemostasis disorders. The cerebrospinal fluid (CSF) changes were consisted with those of purulent bacterial meningitis. Microbiological blood and CSF tests proved N. meningitidis serogroup C. A provisional diagnosis of meningococcemia associated purpura fulminans (PF) was considered. Initial treatment with Medaxon and Penicillin with corticoids was started immediately. In the next days the patient’s condition deteriorated. The skin lesions progressed to involve the whole body, areas of hemorrhagic necrosis appeared. Auto-amputation of the dystal phalanges of II, III, IV and V toe of the right leg and the heel of the left leg occurred. The patient was discharged after a hospital stay of 28-day stay and transferred to the plastic surgery unit. Six years later after 16 reconstructive surgical procedures she was in invalid wheel-chair, a mother of a 2-year-old child.

Keywords: acute meningococcemia, adult patient, clinical course.