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September 4, 1981

Fulminant Meningococcemia After Splenectomy

JAMA. 1981;246(10):1119-1120. doi:10.1001/jama.1981.03320100055033

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 

Case 1.—  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