Thrombolytic therapy in adult meningococcal purpura fulminans with acute renal failure and severe perfusion deficits to the extremities

Objective. To investigate whether systemic administration of recombinant ti ssue plasminogen activator would improve organ perfusion in an adult patien t with fulminant meningococcal disease. Design. Descriptive case report. Patient A 45-year-old female with meningococcal septic shock, purpura fulmi nans and multiple organ failure who was treated in an eight-bed medical int ensive care unit of a University hospital. Intervention. In addition to standard aggressive treatment, on each of thre e consecutive days the patient received recombinant tissue plasminogen acti vator infusions at a dose of 20 mg over 4 hrs. Results. Urine output was recorded before, during, and after the recombinan t tissue plasminogen activator infusions. In addition, the patient's periph eral perfusion status was documented by clinical assessment. The patient sh owed a dramatic improvement in urine output, as well as a perceived increas e in skin perfusion after recombinant tissue plasminogen activator therapy. The amount of exogenous vasopressor and inotropic support required to main tain the patient's hemodynamic status also rapidly decreased. Conclusions. In this adult patient, recombinant tissue plasminogen activato r therapy resulted in improved organ perfusion similar to that reported for paediatric patients. The findings indicate a need for controlled studies c oncerning the use of thrombolytics in severe meningococcal disease.