ACUTE MENINGOCOCCEMIA WITH SYMMETRIC PERIPHERAL GANGRENE: REPORT OF A CASE WITH RECOVERY

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Abstract
A 20-year old white male with acute meningococcemia developed peripheral vascular collapse, multiple bacterial thrombotic sloughs of the skin, and a symmetrical gangrene of the distal digits of the hands and feet. While usual doses of parenteral penicillin and sulfadiazine readily eradicated the bacteremia, large parenteral amounts of soluble hydrocortisone (1000 mg the first day and 500 mg the second) were required to raise and maintain the blood pressure at normal levels. It is felt that the doses of steroids used were not excessive but simply adequate for a patient with such a severe septicemia in whom the adrenal glands were most likely incapable of adequate response to endogenous ACTH. The symmetrical gangrene is believed due to the antimicrobial therapy releasing large amounts of organism endotoxin into tissues previously sensitized to the live meningococcal endotoxin, thereby producing a Shwartzman phenomenon.