2021 Volume 70 Issue 4 Pages 785-790
We report a case of Neisseria meningitidis sepsis that triggered purpura fulminans. The patient was a woman in her 80s. She was brought to our hospital by ambulance because of fever and disturbance of consciousness. Her laboratory findings showed severe inflammatory changes. On physical examination, subcutaneous induration, redness, and purpura of the right lower leg were detected. Chest CT scan showed an infiltrative shadow in the apex area of the left lung. We diagnosed her as having sepsis associated with a soft tissue infection or pneumonia, and the administration of antibiotics (meropenem (MEPM) and vancomycin (VCM)) was started. Gram-negative diplococci were found in blood and sputum cultures. After isolating the diplococcal cells in chocolate agar, a light-gray colony was detected. N. meningitidis was initially suspected from the Gram staining results, but we did not always have a ready supply of meningococcus antigen reagent, so we were not able to confirm it. The result of Gram staining indicated N. meningitidis. We finally diagnosed her as having purpura fulminans associated with sepsis on the basis of N. meningitidis identification. The antibiotics were changed to ceftriaxone (CTRX), and improvement of the inflammation was confirmed. N. meningitidis is a bacterium that is infrequently detected. However, N. meningitidis is highly pathogenic and needs to be detected rapidly. Thus, an examination system for N. meningitidis should be urgently developed.
