PP153 PURPURA FULMINANT IN INVASIVE MENINGOCOCCAL DISEASE: , important of early recognition and treatment

Abstract

Introduction

Invasive meningococcal disease (IMD) is characterized by an abrupt onset of fever, petechial or purpuric rash, which may progress to purpura fulminans, and is often associated with the rapid onset of hypotension, acute adrenal hemorrhage (the Waterhouse–Frider- ichsen syndrome) and multiorgan failure life.

Case report

We report a case of a 2 year-old boy who presented with 3 days history of fever, cough, coryza, vomiting and diarrhoea.  There was a sudden onset of generalized rashes consisting of mixed petechial, purpuric and ecchymosis over the trunk and bilateral lower limbs. Clinically, he was septic looking with poor perfusion. There was no evidence of meningism. Venous blood gas showed compensated metabolic acidosis, thrombocytopenia  and deranged coagulation profile. Blood culture showed Neisseria meningitidis. He was treated with intravenous ceftriaxone and subsequently changed to amikacin and meropenam. He developed purpura fulminants over his upper and lower limbs. Unfortunately he had undergone amputation of his fingers and bilateral foot. He was discharged after 10 weeks. Contact tracing was done and antibiotic prophylaxis was given to contacts. 

Discussion 

Globally, the incidence of IMD is 500,000 cases every year. Death occurs in 6-10% of IMD cases and sequelae in 4.3-11.2% of cases. Common sequelae were hearing loss, deafness, seizure, amputation and skin scarring. The classic laboratory diagnosis of meningococcal disease has relied on bacteriologic culture while PCR offers more rapid diagnosis. Treatment using IV ceftriaxone/cefotaxime should be given as soon as meningococcal disease is suspected. Chemoprophylaxis should be given to close contacts within 7 days.

Conclusion

IMD requires prompt diagnosis and instillation of antibiotics. Prevention of IMD with immunisation is of utmost importance to prevent mortality and morbidity. Meningococcal immunisation should be in our National Immunisation Program.