TREATMENT OF THROMBOEMBOLIC COMPLICATIONS OF FULMINANT MENINGOCOCCAL SEPTIC SHOCK

A patient report of fulminant meningococcal septic shock is described. The presentation, hospital course, and reconstructive efforts are out lined, and a brief review of meningococcal infection is included. Emph asis is placed on the algorithm used to determine treatment. A 19-year -old Hispanic male presented with all the hallmarks of Waterhouse-Frid erichsen syndrome (WFS)-sudden onset, high fever, dyspnea with intermi ttent cyanosis, shock, disseminated intravascular coagulopathy, and th e development of purpura. The pathognomonic feature of WFS-hemorrhage into the adrenal glands-if present, was not extensive, as he did not r equire steroid supplementation. Though cerebrospinal fluid latex agglu tination was negative, his serum was positive for group C Neisseria an d admission blood cultures grew Neisseria meningitidis. Thromboembolic complications were systemic with the highest morbidity peripherally i n the lower extremities. Care for these injuries involved every rung o f the reconstructive ladder-from local wound care and skin grafts to l ocal flaps and microvascular transplantation.