Acute meningococcaemia complicated by late onset gastrointestinal vasculitis.
Extra-meningeal and non-cutaneous manifestations of meningococcal infection are well recognized but rare. Herein we report a little recognized complication of meningococcaemia, namely late-onset gastrointestinal vasculitis. In the case presented, the prostacycline analogue iloprost was used in an attempt to minimize incipient digital gangrene ina patient with evidence of protracted immunological phenomena. In addition, diclofenac was used to treat severe arthralgia. Withdrawal of iloprost on day 19 was associated with abdominal pain and peritonism. Laparotomy demonstrated ischaemia and ulceration in the caecum, and histology revealed full thickness mucosal ulceration with a prominent vasculitic process. It is postulated that these findings were immunologically mediated, with possible rebound vasoconstriction following withdrawal of iloprost. It is also possible that NSAID use contributed to the findings via cyto-toxicity to mucosal cells.
Seaton
R A
RA
Infection and Immunodeficiency Unit, Kings Cross Hospital, Dundee, UK.
Nathwani
D
D
Dick
J
J
Smith
D
D
D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D016470:Bacteremia / Q000150:complications; D005767:Gastrointestinal Diseases / Q000209:etiology*; D006801:Humans; D016285:Iloprost / Q000009:adverse effects; D008297:Male; D008589:Meningococcal Infections / Q000150:complications*; D009345:Neisseria meningitidis / Q000302:isolation & purification; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D013997:Time Factors; D014657:Vasculitis / Q000209:etiology*; D014665:Vasodilator Agents / Q000009:adverse effects
D000894:Anti-Inflammatory Agents, Non-Steroidal; D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D016285:Iloprost