Carnelli V, Turconi A, Stucchi C, Giovanniello A, Perri M, Portaleone D
Cattedra di Ematologia Pediatrica, Università di Milano, Italia.
Pediatr Med Chir. 1991 Jan-Feb;13(1):91-3.
Disseminated intravascular coagulation (DIC) is a frequent complication of meningococcal sepsis in children. The clinical course variability, the severity of manifestations and the need of an early diagnosis for appropriate treatment, guides us to report a case of meningococcal sepsis and DIC. The patient, male, prematurely born, 11 months years old, presented himself with high fever of sudden onset, malaise, diarrhea, diffuse skin rash with abdominal petechiae, and no clinical evidence of meningitidis. Initial hematochemical findings, peripheral leukocytosis, quantitative and qualitative changes in plasma coagulation factors, liquoral hypocellularity together with the development of signs of meningeal irritation (stiff neck and back) were considered diagnostic clues for meningococcal sepsis associated with DIC. A gram-negative diplococcus was cultured from liquor. Primary goals of the treatment of this life-threatening clinical picture were the elimination of the bacterial component, the correction of clotting disorders and careful control of shock and metabolic acidosis often related with DIC. The patient then received a wide spectrum Cephalosporin, fresh frozen plasma, appropriate electrolyte solutions and eventually heparin, which led to a complete control and resolution of symptomatology.
弥散性血管内凝血（DIC）是儿童脑膜炎球菌败血症常见的并发症。鉴于临床病程的多变性、临床表现的严重程度以及早期诊断以进行恰当治疗的必要性，我们报告一例脑膜炎球菌败血症合并DIC的病例。该患者为男性，早产，11个月大，突发高热、不适、腹泻、伴有腹部瘀点的弥漫性皮疹，且无脑膜炎临床证据。初始血液生化检查结果、外周血白细胞增多、血浆凝血因子的数量和质量变化、脑脊液细胞减少以及脑膜刺激征（颈部和背部僵硬）的出现，均被视为脑膜炎球菌败血症合并DIC的诊断线索。从脑脊液中培养出革兰氏阴性双球菌。治疗这种危及生命的临床症状的主要目标是消除细菌成分、纠正凝血障碍以及仔细控制常与DIC相关的休克和代谢性酸中毒。该患者随后接受了广谱头孢菌素、新鲜冰冻血浆、适当的电解质溶液，最终使用了肝素，症状得到了完全控制并得以缓解。
