Fatal meningococcemia mimicking intra-abdominal emergency

Excerpt

A 24-year-old man was admitted for recent acute abdominal pain, chills, vomiting, and 39 °C fever. His clinical examination revealed no neurological (specifically, no neck stiffness) or cutaneous abnormalities. The initial laboratory workup revealed mild thrombocytopenia (102 G/L) and blood smear showed rare diplococci (Fig. 1a–c). Four hours after admittance, despite ceftriaxone and gentamicin treatment, tachycardia, oxygen desaturation, polypnea, and mottling appeared. Laboratory test revealed disseminated intravascular coagulation (APTT ratio 3.80, PT 24%, FII 75%, FV 11%, fibrinogen < 0.4 g/L, D-dimers > 35,000 ng/mL, severe thrombocytopenia 15 G/L). Blood smear exhibited many diplococci in neutrophils (Fig. 1d, e). Despite intensive care, the patient died of multi-organ failure 8 h after admittance. Confirmatory microbiological tests were positive for Neisseria meningitidis serogroup W.

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