|Year : 1991 | Volume
| Issue : 1 | Page : 19-21
Cutaneous manifestations in acute meningococcal meningitis
N Chakrabarty, AK Verma, G Singh
Source of Support: None, Conflict of Interest: None
Twenty three army recruits with acute meningococcal meningitis were admitted to a military hospital during February-March 1986. Of the 23 patients 11 developed cutaneous lesions, 3 had associated herpes simplex, 6 had arthritis/artharalgia and 3 got conjunctivitis. Maculopapular lesions were the commonest cutaneous manifestation although pinkish macules, purpura and cutaneous vasculitis were also seen. All the patients were treated with intravenous pencillin and other supportive measures.
Keywords: Acute meningococcal meningitis, Cutaneous manifestations
|How to cite this article:|
Chakrabarty N, Verma A K, Singh G. Cutaneous manifestations in acute meningococcal meningitis. Indian J Dermatol Venereol Leprol 1991;57:19-21
|How to cite this URL:|
Chakrabarty N, Verma A K, Singh G. Cutaneous manifestations in acute meningococcal meningitis. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2020 Jun 3];57:19-21. Available from: http://www.ijdvl.com/text.asp?1991/57/1/19/3611
Meningococcal meningitis is a well described clinical entity. Its neurological manifestations are largely well understood. At times it may cause cutaneous lesions which may be quite a intriguing. The recent epidemic of meningococcal meningitis in an army camp has offered an opportunity to define its pattern. Similar report on the subject has focused our attention on the situation. 
| Materials and Methods|| |
Twenty three patients of acute meningococcal meningitis were studied in detail. Patients were examined in the morning and evening for the development and progress of cutaneous lesions. Haemolgobin, total and differential white cell count, platelet count and blood culture were done in all cases. CSF examination for diplococci, cell counts, biochemistry and culture were done before starting treatment. Smears from skin lesions were stained with Gram stain for the demonstration of gram negative diplococci. Skin biopsy was performed in 4 cases - 2 with maculopapular lesions and 2 with necrotizing ulcers.
| Results|| |
All patients were male army recruits aged between 17 and 21 years. Eleven (47.82%) out of 23 developed various types of skin lesions [Table 1], six patients (54.54%) had mixed lesions with one type predominant, but all the patients having pinkish macules and vasculitis did not have any other lesion. Widespread lesions on face, trunk, limbs and soles were seen in patients with maculopapular and purpuric lesions.
One case of vasculitis had ulcers on lips, upper and lower extremities and the other one had on buttocks and lower limbs. Initially dark patches appeared on the lips and skin. After 24 to 36 hours bullae appeared on the patches which burst in 2 days leading to shallow ulcers covered with crusts. Cutaneous lesions were observed within a few hours to 3 days and vasculitis from 7 to 10 days.
Twenty one patients (91.3%) had fever but two patients were afebrile. Six patients (26.1%) developed arthritis/arthralgia and three (13.1%) developed conjunctivitis and herpes labialis. One patient (4.4%) had mucous membrane involvement.
The fulminating case on admission had few purpuric spots on the trunk and extremities and was afebrile. However he developed generalised purpuric and ecchymotic lesions within 4 hours and expired 2 hours thereafter.
Total white counts varied from 4,500/cmm to 22,100/cmm. Platelet counts were within normal limit in all cases except the fatal case who had a count of 70,000 cmm. CSF cell (Polymorphs) counts varied from 450 to 2100/ cmm, sugar and chloride were decreased and protein was raised in all cases.
The maculopapular lesions showed oedema of epidermis and infiltration of the basal cell layer with polymorphs. The blood vessels of upper and mid dermis were oedematosus and dilated and had perivascular infiltration with polymorphs. Ulcerative lesions showed pronounced changes in the blood vessels in both superficial and deep dermis. There was oedema, arteriolar thrombosis, and necrosis associated with intense perivascular and periappendiceal infiltration with polymorphs and mononuclear cells. The lumen as well as the wall of the blood vessels were infiltrated. No gram negative diplococci could be demonstrated in the biopsy specimen. The maculopapular and pink macules disappeared within 6 to 8 days and purpuric spots within 7 to 11 days. The ulcers healed between 9 to 13 days.
| Comments|| |
Meningococcal meningitis primarily affects children and occurs frequently in winter . Outbreak in crowded relatively close groups like recruits in a training Camp  and in military barracks have been reported from western countries , All the patients were from rural areas and had undergone 4 to 10 weeks of military training. These individuals either did not have any resistance against meningococcus or were unusually susceptible to infection.
Cutaneous lesions were seen in 47.82% although higher incidence had been reported.  The cutaneous lesions can be divided into pure cutaneous lesions consisting of macules, maculopapules, purpura and ecchymosis.
Cutaneous lesions associated with other complications are cutaneous vasculitis, arthritis and eye lesions.
Association of other skin infection like herpes simplex was seen in patients.
Maculopapular lesions were the commonest and the second commonest were the pinkish macules mostly distributed on trunk, palms and soles. The skin lesions appeared in crops and were polymorphic but one type was predominant. The macular, maculopapular and petechial skin lesions are caused by the damage of small dermal blood vessels either due to direct invasion by meningococcus  or the effects of endotoxin via dermal Schwartzman reaction . Vasculitis is mostly due to immunes complex reaction , and skin biopsies showed features of Leucocytoclastic vasculitis.
Fulminating meningococcemia often causes wide spread intravascular coagulation ,, with high mortality and the fulminant case in the present study had all the features of wide spread intravascular coagulation.
Rare complications like gangrene, bacterial endocarditis, pneumonia and nephritis were not seen.
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