Mele J A, Linder S, Capozzi A
Division of Plastic and Reconstructive Surgery, Saint Francis Memorial Hospital, Bothin Burn Center, San Francisco, CA 94109, USA.
Ann Plast Surg. 1997 Mar;38(3):283-90. doi: 10.1097/00000637-199703000-00017.
A patient report of fulminant meningococcal septic shock is described. The presentation, hospital course, and reconstructive efforts are outlined, and a brief review of meningococcal infection is included. Emphasis is placed on the algorithm used to determine treatment. A 19-year-old Hispanic male presented with all the hallmarks of Waterhouse-Friderichsen syndrome (WFS)-sudden onset, high fever, dyspnea with intermittent cyanosis, shock, disseminated intravascular coagulopathy, and the development of purpura. The pathognomonic feature of WFS-hemorrhage into the adrenal glands-if present, was not extensive, as he did not require steroid supplementation. Though cerebrospinal fluid latex agglutination was negative, his serum was positive for group C Neisseria and admission blood cultures grew Neisseria meningitidis. Thromboembolic complications were systemic with the highest morbidity peripherally in the lower extremities. Care for these injuries involved every rung of the reconstructive ladder-from local wound care and skin grafts to local flaps and microvascular transplantation.
本文描述了一例暴发性脑膜炎球菌败血症休克的病例报告。概述了其临床表现、住院过程及重建治疗情况，并对脑膜炎球菌感染进行了简要回顾。重点介绍了用于确定治疗方案的算法。一名19岁的西班牙裔男性表现出华-佛综合征（WFS）的所有特征——起病急、高热、伴有间歇性发绀的呼吸困难、休克、弥散性血管内凝血以及紫癜的出现。WFS的特征性表现——肾上腺出血（若存在）并不广泛，因为他不需要补充类固醇。尽管脑脊液乳胶凝集试验为阴性，但他的血清C群奈瑟菌呈阳性，入院血培养生长出脑膜炎奈瑟菌。血栓栓塞并发症累及全身，下肢外周发病率最高。对这些损伤的治疗涉及重建阶梯的各个层面——从局部伤口护理和皮肤移植到局部皮瓣和微血管移植。
