Sonavane Alka, Baradkar Vasant, Salunkhe Parul, Kumar Simit
Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India.
Indian J Dermatol. 2011 May;56(3):326-8. doi: 10.4103/0019-5154.82496.
Waterhouse-Friderichsen syndrome is one of the fatal complications of meningococcal infection. Here we report a fatal case of this syndrome due to Neisseria meningitidis in a 29-year-old male patient who was admitted with high-grade fever and chills and vomiting since 7 days, a skin rash over the abdomen and trunk, and altered sensorium since 2 days. On examination, the signs of meningitis were present along with the hemorrhagic rash. The diagnosis of adrenal hemorrhage was confirmed by computerized tomographic scan findings. The patient was started on intravenous ceftriaxone, and the cerebrospinal fluid was processed for bacterial culture, which yielded growth of N meningitidis. The patient's condition deteriorated; he developed purpura along with a fall in platelet count, and died due to shock. This case is being reported as such a complication is comparatively rare in this antibiotic era, especially in adults, and starting steroids like dexamethasone prior to antibacterial therapy may be useful to diminish the inflammation brought about by bacterial cell death and thus help in reducing the otherwise high mortality in these cases.
华-佛综合征是脑膜炎球菌感染的致命并发症之一。在此，我们报告一例29岁男性患者因脑膜炎奈瑟菌导致的该综合征致死病例。该患者自7天前起出现高热、寒战及呕吐，2天前腹部和躯干出现皮疹，且意识状态改变。检查时发现存在脑膜炎体征及出血性皮疹。肾上腺出血的诊断通过计算机断层扫描结果得以证实。患者开始静脉注射头孢曲松，并对脑脊液进行细菌培养，培养结果显示有脑膜炎奈瑟菌生长。患者病情恶化；出现紫癜且血小板计数下降，最终因休克死亡。报告该病例是因为在这个抗生素时代，此类并发症相对罕见，尤其是在成年人中，并且在抗菌治疗前使用地塞米松等类固醇药物可能有助于减轻细菌细胞死亡所带来的炎症，从而有助于降低这些病例原本较高的死亡率。
