Fibrinolytic therapy with recombinant tissue plasminogen activator in meningococcemia and purpura fulminans

A case of a 16 years old young man with meningococcemia, septic shock and p urpura fulminans is presented. The clinical course was complicated by ische mia of both lower legs and feet as well as both cheeks. After successful re storation of circulation, the lower legs remained ischemic and loss was imm inent. Therefore, fibrinolytic therapy with recombinant tissue plasminogen activator (rt-PA) was started: Both lower legs and feet could be preserved. All of the toes of the right foot, however, had to be amputated. Discussio n: Fibrinolytic therapy with rt-PA should be considered as a therapeutic op tion in patients with meningococcemia and purpura fulminans with imminent l oss of extremities. Optimal perfusion pressure and control of coagulation s eems to be a prerequisite for successful fibrinolytic therapy. Care should be taken to avoid complications, especially intracerebral hemorrhage.