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Fulminant Meningococcemia Presenting as Acute Gastroenteritis FREE TO VIEW

Jordan Taillon, MD; Divya Chode, MD; Thomas Russi, MD
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New York Methodist Hospital, Brooklyn, NY

Chest. 2014;146(4_MeetingAbstracts):290A. doi:10.1378/chest.1990616
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SESSION TITLE: Critical Care Student/Resident Case Report Posters I

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Neisseria meningococcemia typically presents with fever and headache associated with a purpuric rash. Presenting symptoms of acute gastroenteritis is considered to be a rare manifestation of meningococcemia in adults, posing a challenge to a correct clinical diagnosis. Here, we report a case of a patient with symptoms of acute gastroenteritis who was ultimately diagnosed with acute meningococcemia

CASE PRESENTATION: A previously healthy 29-year-old man presented with 2 days of nausea, vomiting, abdominal discomfort, weakness, and fever that reportedly started after he ate seafood. In the ER, he had diarrhea and was noted to be febrile, tachycardic, and hypotensive. Physical exam showed an awake, diaphoretic male with minimal abdominal tenderness. There were no meningeal signs or hemorrhagic rash. Labs were significant for leukocytosis, thrombocytopenia, and an elevated lactate. He had acute renal failure and shock liver, consistent with peripheral circulatory failure and required vasopressor support. Blood film revealed no evidence of red blood cell hemolysis or fragmentation and CT Abdomen was benign. A presumptive diagnosis of septic shock from acute gastroenteritis was made. Ciprofloxacin and Metronidazole were started and he was admitted to ICU. It was only when initial blood cultures grew Neisseria Meningococcus that Ceftriaxone was initiated on day 2 of hospitalization. The patient’s condition rapidly improved with Ceftriaxone and his blood work soon showed resolution of his end organ injury. He was discharged home after 6 days on IV Ceftriaxone without any further complications.

DISCUSSION: Acute meningococcemia mimicking an acute gastroenteritis is a rare initial clinical presentation that is sporadically seen in children but only reported in 3 adults in the medical literature. Of the 3 reported cases, our patient was the only one to survive and did not have any ensuing complications. This could be due to the early recognition of infection and initiation of antibiotics in an otherwise healthy, young adult who had no evidence of hemorrhage or DIC. The exact pathogenesis of this unusual course of events remains unclear but it can be hypothesized that the gastroenteritis symptoms are due to the direct effect of endotoxins released within the gastrointestinal tract

CONCLUSIONS: This case illustrates the importance of recognizing a fatal infection presenting with uncommon symptoms. The possibility of meningococcemia should be considered in any seriously ill patient with gastroenteritis and the prompt recognition of this disease is essential for reducing morbidity and mortality.

Reference #1: Reference #1: Kearsley JH, Delchery J, Croll FJ, et al. Fulminant Meningococcemia. Aust N Z J Med. 1981 Apr; 11(2):187-90.

Reference #2: Reference #2: Waldum HL, Fuglesang JE, et al. Fulminant Meningococcemia starting as an acute gastroenteritis. Scand J Infect. Dis.1977; 9(4): 309-10.

DISCLOSURE: The following authors have nothing to disclose: Jordan Taillon, Divya Chode, Thomas Russi

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Fulminant meningococcemia. Aust N Z J Med 1981;11(2):187-90.
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