|Year : 1993 | Volume
| Issue : 1 | Page : 31-32
Meningococcaemia with gangrene
Source of Support: None, Conflict of Interest: None
A 2½ year old boy of meningococcaemia with rare complications like gangrene of the digit, tip of the nose and both helix is reported. Importance of timely suspicion and early intervention with antibiotic to change the fatal course of meningococcaemia is discussed.
Keywords: Meningococcal infections, Purpura, Gangrene
|How to cite this article:|
. Meningococcaemia with gangrene. Indian J Dermatol Venereol Leprol 1993;59:31-2
| Introduction|| |
Meningococcaemia is an acute bacterial illness which may vary from a mild respiratory illness to fulminant septicaemia associated with purpuric eruption.  It is an important cause of childhood mortality and the best prospect for reducing mortality in the short term is improved treatment. A case of meningococcaemia with gangrene is reported.
| Case Report|| |
A 2 1/2 old year boy with prodrome of upper respiratory infection followed by macular and purpuric rashes which developed on the second day of admission was referred to a dermatologist. Cutaneous examination revealed acral cyanosis, erythematous maculopapular rash over the trunk, purpuric lesions over the gluteal region, extremities, face, and scrotal skin [Figure - 1]. Purpuric lesions had angulated outlines and at places were arranged in livedo reticularis pattern.
Except for tachycardia, other systems were within normal limits. Gram's stain smear revealed intracellular diplococci. Coagulation profile was normal except thrombocytopenia and leucocytosis.
The child was given I V penicillin 5 LU, qds and supportive measures with a provisional diagnosis of meningococcaemia after withdrawing blood for culture. CSF cytochemistry was not attempted as there were no signs suggestive of meningitis. Culture grew N. meningitidis and confirmed the diagnosis. On fifth day the child developed central ulceration of purpuric lesions over gluteal region and gangrene of the right little finger, tip of the nose, and helix of both ears. With I V penicillin treatment for 10 days, lesions healed and gangrenous parts got auto-amputated.
| Comments|| |
Acute meningococcaemia develops when N. meningitidis, present in the upper respiratory tract, invades the blood stream. At increased risk for invasive disease are those individuals without prior exposure to organism, especially children under 5 years of age.  In the present case skin- lesions seem to arise mainly from bacteria-induced vascular damage rather than disseminated intravascular coagulation (DIC), as N. meningitidis was demonstrable both by Gram's stain and culture with normal coagulation profile. Thrombocytopenia can be due to direct effect of bacterial agent on thrombocytes.  If DIC has a role, additional heparin therapy is a must. Complications like gangrene encountered in the present case are scarcely reported in the literature.
Toews and Bass  found that the type of rash on admission to hospital had prognostic significance-, of 114 with macular, papular, or petechial lesions, 3 died; but of 116 with a purpuric or ecchymotic rash, 7 died. So progression of the rash often coincides with clinical deterioration.
| References|| |
|1.||Fisher M, Katz S. Fever and rash. In : Difficult diagnosis in Dermatology (Labwhol M, ed). New York: Churchill Livingstone, 1988; 173-4. |
|2.||Hirschmann JV. Cutaneous signs of systemic bacterial infection. In : Principle and Practice of Dermatology (Sams WM, Lynch Pi, eds), 1st edn. New York: Churchill Livingstone, 1990; 90-1. |
|3.||Toews WH, Bass JW. Skin manifestations of meningococcal infection. An immediate indicator of prognosis. Am J Dis Child 1974; 127: 173-6. [PUBMED] |
[Figure - 1]