Atypical presentation of fatal meningococcemia: peritonitis and paradoxical centrifugal purpura fulminans of late onset

作者：Wendlandt David^*; King Ben; Ziebell Chris; Milling Truman

来源：American Journal of Emergency Medicine, 2011, 29(8): 960.e3.

DOI：10.1016/j.ajem.2010.08.019

Here we report an atypical case of meningococcemia presenting as peritonitis and later developing a centrifugal rash. The patient was a previously healthy 21-year-old Hispanic man who presented to the emergency department (ED) with a low-grade fever, right lower quadrant pain, and right lower extremity myalgia. Physical examination was suggestive for appendicitis, and the patient was showing signs of septic shock: hypotension, tachypnea, tachycardia, and a mottled appearance shortly after admission. Exploratory surgeries of the abdominal cavity and right lower extremity were unable to identify the nidus of infection. Eight hours after admission, the patient was noted to have a petechial rash, which rapidly progressed to purpura fulminans (PF) within the first hour of its initial appearance. Paradoxically, however, the petechiae and confluent ecchymosis were initially far more prominent proximally in this patient-largely sparing the distal extremities early in its course. Purpura fulminans always manifests distally and rarely affects the face. By contrast, the rash in our patient first developed proximally, being especially prominent on his trunk and back, and was also associated with a large degree of facial involvement. Blood cultures and fluid sampled from the peritoneal cavity grew Neisseria meningitidis.

• 出版日期2011-10