Sir.—I disagree with the conclusions of Toews and Bass that appeared in the February issue of the Journal (127:173, 1974).
Peripheral purpuric or ecchymotic skin lesions that are necrotic can be compatible with a good prognosis, especially if purpuric cutaneous lesion is accompanied by a hard subcutaneous nodule (little thrombosed vessel with cell infiltration) or if the necrotic lesion is surrounded by a thin bullous lesion. These cases have a rather good prognosis and numerous meningococci are found either in the subcutaneous cell infiltrate or in the droplet from the thin bullous peripheral lesion. Such favorable cases are described by Marie et al.1