FULMINANT bacterial infections complicated by shock and disseminated intravascular coagulation have been reported after splenectomy for trauma.1-3 The majority of these infections are caused by bacteria with polysaccharide capsules; pneumococci are demonstrated in half of the cases.4 We report two cases of atypical Waterhouse-Friderichsen syndrome from meningococcemia in asplenic young women who did not manifest skin lesions.
Report of Cases
A 17-year-old girl came to a small hospital emergency room with a one-day history of fever. Malaise and transient blurred vision were noted. About eight hours previously her roommate noted her to be confused. Medical history included a splenectomy after abdominal trauma at age 13 years. She was cyanotic and unresponsive in the emergency room. No skin lesions were present. Shortly after arrival she had a cardiac arrest, and resuscitation measures were unsuccessful. Autopsy showed purulent meningitis, splenosis, and scleral, pulmonary, and bilateral adrenal hemorrhage. Typing
Holmes FF, Weyandt T, Glazier J, Cuppage FE, Moral LA, Lindsey NJ. Fulminant Meningococcemia After Splenectomy. JAMA. 1981;246(10):1119–1120. doi:10.1001/jama.1981.03320100055033
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