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[Meningococcal sepsis and DIC in childhood: a report of a clinical case]
V Carnelli1, A Turconi, C Stucchi
1Cattedra di Ematologia Pediatrica, Università di Milano, Italia.
Insights
Meningococcal sepsis in children can cause disseminated intravascular coagulation (DIC). Early diagnosis and treatment, including antibiotics and blood products, are crucial for managing this severe condition.
Area of Science:
- Pediatrics
- Infectious Diseases
- Hematology
Background:
- Disseminated intravascular coagulation (DIC) is a known complication of meningococcal sepsis in pediatric patients.
- The variability in clinical presentation necessitates a high index of suspicion for early diagnosis.
Observation:
- An 11-month-old premature male presented with fever, rash, and gastrointestinal symptoms, initially without clear signs of meningitis.
- Hematological findings revealed leukocytosis and coagulation factor abnormalities, alongside cerebrospinal fluid analysis showing hypocellularity.
- Development of meningeal irritation signs (stiff neck, back) alongside sepsis symptoms confirmed the diagnosis.
Findings:
- Cerebrospinal fluid culture identified a gram-negative diplococcus, confirming Neisseria meningitidis.
- The patient exhibited classic signs of meningococcal sepsis with associated disseminated intravascular coagulation.
- Treatment involved broad-spectrum cephalosporins, fresh frozen plasma, supportive care, and heparin for coagulation management.
Implications:
- This case highlights the importance of recognizing atypical presentations of meningococcal sepsis in infants.
- Prompt and aggressive management, addressing both infection and coagulopathy, is vital for patient survival.
- Effective treatment strategies include antibiotics, coagulation factor replacement, and anticoagulation when indicated.
Abstract:
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.