Images in Clinical Medicine

Meningococcemia

Robert Gomez, M.D., and E. Stephen Buescher, M.D.

N Engl J Med 1997; 336:707March 6, 1997

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Figure 1 A 14-year-old boy with a four-year history of systemic lupus erythematosus (controlled by daily treatment with 5 mg of prednisone) reported feeling weak and warm and subsequently began to have abdominal pain and vomiting. The next morning, because of fever and malaise, he was taken to the emergency department, where he was found to be hypotensive, with cool, cyanotic hands and feet. Neither petechiae nor purpura was present; no meningismus was noted. The white-cell count was 4400 per cubic millimeter (37 percent segmented cells, 17 percent band forms, 3 percent metamyelocytes, 1 percent myelocytes, 35 percent lymphocytes, 4 percent monocytes, 2 percent eosinophils, and 1 percent atypical lymphocytes). Blood was cultured, blood gases were analyzed, serum chemical analyses were performed, and ceftriaxone and hydrocortisone were administered. The peripheral-blood smear (Panels A and B; Wright's stain, ×1250) contained many leukocytes with multiple blue inclusions (arrows); Gram's stain of the buffy coat (Panels C and D; ×1250) revealed gram-negative cocci and diplococci in many leukocytes. The patient was hospitalized in the intensive care unit but died of irreversible shock and acidosis after 48 hours. The culture of blood obtained at admission grew Neisseria meningitidis group B.

Robert Gomez, M.D.
E. Stephen Buescher, M.D.
Children's Hospital of the King's Daughters, Norfolk, VA 23507-1921

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