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Autopsy and Medicine
October 12, 1998

Case of the Month: Allaying Apprehension

Dean M. Havlik, MD; Rebecca Irvine, MD; Randy Hanzlick, MD; et al and the Autopsy Committee of the College of American Pathologists
Arch Intern Med. 1998;158(18):1971-1972. doi:10.1001/archinte.158.18.1971

A 39-YEAR-OLD white man noticed a rash on his legs 10 days before death, but he did not seek medical attention. He also experienced increasing fatigue. Two days before death, he went to a primary care physician with complaints of a sore throat. At this time, he was diagnosed as having tonsillitis and pharyngitis and was sent home with a prescription for antibiotics. The medical records did not indicate the presence of a skin rash. On the day of death, he came into the emergency room with a fever and weakness. He quickly became unresponsive to stimuli. The emergency department physicians noted lower extremity petechiae and localizing neurological signs on the right side. Approximately 2 hours after presentation, he was pronounced dead. The patient had no notable medical history. The family and emergency department physicians requested an autopsy to determine the cause of death. The physicians were justifiably concerned about meningococcal meningitis and the possibility of infectious exposure of the staff and community.