Fulminant Meningococcaemia With Purpura Fulminans and Multiple Organ Failure In An Immunocompetent Adult Patient

Abstract

Fulminant meningococcaemia (FM) is a rare severe life threatening illness caused by Neisseria (N.) meningititis. FM can cause different complications such as septic shock and purpura fulminans. Early aggressive treatment like fluid infusion and antibiotic therapy can improve the survival rate. A 41 year old previously healthy woman was admitted to the intensive care unit (ICU) from the emergency department due to septic shock and purpura fulminans. On ad- mission to ICU, the patient presented with features of septic shock. Due to re- spiratory failure the patient was intubated. Within hours as well as acute renal failure, disseminated intravascular coagulation (DIC) occurred. Aggressive flu- id therapy, broad spectrum antibiotics and vasopressors were given. In addi- tion, hemodialysis and plasma exchange was initiated. On 5th day, N. menengiti- tis was isolated from the patient’s blood culture, which was drawn at the emer- gency room. On 14th day the patient was extubated. The patient’s neurological examination was completely normal. On 32nd day the patient was transferred to the Plastic Surgery Department, where she underwent right food amputation from the metatarsopharengeal joint. Then she was discharged from the Plastic Surgery Department. Meningococcal infection should be considered in the dif- ferential diagnosis of any patient with sudden onset of a febrile illness, with pe- techiae and/or meningeal signs. A person who has any risk factor should be vac- cinated for meningococcal disease. Anyone who had close contact with the in- dex patient should take antimicrobial chemoprophylaxis immediately.