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Late skeletal deformities following meningococcal sepsis and disseminated intravascular coagulation
Abstract:
Late skeletal deformities following meningococcemia associated with disseminated intravascular coagulation are rare. Two basic lesions have been described: epiphyseal avascular necrosis and epiphyseal-metaphyseal defects. These occur primarily in the lower extremities and result in angular deformity and leg length inequality. We recently encountered these lesions in a child 3 years following sepsis. The etiology appears to be acute vascular thrombosis of epiphyseal and metaphyseal vessels mediated through the generalized Shwartzman reaction. An increased incidence of these deformities may be anticipated as more children survive fulminant meningococcemia.
Insights
Late skeletal deformities, including avascular necrosis and defects, can occur after meningococcemia with disseminated intravascular coagulation. These rare complications primarily affect lower extremities, causing limb length discrepancies and angular deformities.
Area of Science:
- Pediatric Orthopedics
- Infectious Disease Complications
- Vascular Pathology
Background:
- Meningococcemia, a severe bacterial infection, can lead to disseminated intravascular coagulation (DIC).
- DIC is a life-threatening condition that consumes clotting factors and platelets, leading to abnormal bleeding and clotting.
- Late skeletal deformities are rare but recognized sequelae of meningococcemia-associated DIC.
Observation:
- Two primary types of skeletal lesions have been described: epiphyseal avascular necrosis and epiphyseal-metaphyseal defects.
- These lesions predominantly affect the lower extremities.
- A recent case documented these deformities in a child three years post-sepsis.
Findings:
- The underlying etiology is believed to be acute vascular thrombosis in epiphyseal and metaphyseal vessels.
- This thrombosis is likely mediated by the generalized Shwartzman reaction, a severe complication of DIC.
- The vascular compromise leads to bone necrosis and subsequent deformities.
Implications:
- As survival rates for severe meningococcemia improve, an increased incidence of these skeletal deformities may be observed.
- Early recognition and management of DIC in meningococcemia are crucial to potentially mitigate long-term orthopedic complications.
- Further research is needed to understand the precise mechanisms and develop preventative strategies for these rare but significant deformities.