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Recombinant tissue plasminogen activator restores perfusion in meningococcal purpura fulminans
L T Aiuto1, S R Barone, P S Cohen
1Department of Pediatrics, North Shore University Hospital-New York University School of Medicine, Manhasset 11030, USA.
Objective:
To investigate whether an infusion of recombinant tissue plasminogen activator would dissolve microvascular thromboses and improve organ perfusion in a patient with fulminant meningococcemia.
Design:
Descriptive case report.
Setting:
Fifteen-bed pediatric intensive care unit (ICU) in a university hospital.
Patient:
A 4-month-old male with fulminant meningococcemia, refractory shock, and multiple organ failure.
Interventions:
In addition to standard aggressive ICU care, the patient received a recombinant tissue plasminogen activator infusion at a total dose of 1.25 mg/kg over 4 hrs.
Measurements And Main Results:
Heart rate, arterial blood pressure, urine output, and base deficit (as a reflection of severity of metabolic acidosis) were recorded immediately before the recombinant tissue plasminogen activator infusion and 4 hrs later, after completion of the recombinant tissue plasminogen activator infusion. The amount of exogenous vasopressor and inotropic support required to maintain the patient's hemodynamic status before and after recombinant tissue plasminogen activator infusion were also compared. Subjective observations regarding the patient's peripheral perfusion status were also noted. The patient showed a dramatic improvement in hemodynamics, urine output, and metabolic acidosis, as well as a perceived increase in skin perfusion after recombinant tissue plasminogen activator infusion.
Conclusions:
In this patient, recombinant tissue plasminogen activator infusion resulted in improved organ perfusion and cardiac performance. Selective use of recombinant tissue plasminogen activator in the treatment of fulminant meningococcemia merits further investigation.
Insights
Recombinant tissue plasminogen activator infusion improved organ perfusion and hemodynamics in a patient with severe meningococcemia. Further investigation is warranted for this potential treatment of fulminant meningococcemia.
Area of Science:
- Critical Care Medicine
- Pediatric Intensive Care
- Pharmacology
Background:
- Fulminant meningococcemia can lead to refractory shock and multiple organ failure.
- Microvascular thrombosis is a key pathophysiological feature of severe meningococcemia.
- Limited treatment options exist for advanced meningococcemia.
Observation:
- A 4-month-old male with fulminant meningococcemia presented with refractory shock and multi-organ failure.
- The patient received a recombinant tissue plasminogen activator (rt-PA) infusion in addition to standard ICU care.
- Hemodynamic parameters, urine output, and metabolic acidosis were monitored before and after rt-PA infusion.
Findings:
- The rt-PA infusion led to dramatic improvements in hemodynamics, urine output, and metabolic acidosis.
- Peripheral perfusion and cardiac performance were notably enhanced post-infusion.
- Reduced need for vasopressor and inotropic support was observed.
Implications:
- Recombinant tissue plasminogen activator may be a potential therapeutic option for microvascular thrombosis in fulminant meningococcemia.
- Selective rt-PA use warrants further investigation in treating severe meningococcemia.
- This case highlights a novel approach to managing a life-threatening pediatric condition.