title: Severe myalgia of the lower extremities as the first clinical feature of meningococcal purpura fulminans.
abstract: In patients with meningococcal infection, devastating presentations, such as purpura fulminans, which can progress to extensive tissue necrosis of the limbs and digits, have a significant social impact. The case presented herein illustrates such a phenomenon in a patient who developed bilateral necrosis of the lower extremities as a result of infection with Neisseria meningitis. We emphasize that severe myalgia was the first clinical manifestation of meningococcal purpura fulminans in our case. However, myalgia has typically been overlooked and undervalued as an early clinical feature of meningococcal sepsis. Early recognition and prompt initial antibiotic therapy continue to be the cornerstones of the successful management of this dramatic disease, reducing morbidity and mortality.
authors.affiliation: Intensive Care Unit, Emílio Ribas Institute of Infectology, São Paulo, Brazil. alexandre@emilioribas.sp.gov.br
authors.forename: Alexandre Leite
authors.initials: AL
authors.lastname: de Souza
authors.forename: Jaques
authors.initials: J
authors.lastname: Sztajnbok
authors.forename: Maristela Marques
authors.initials: MM
authors.lastname: Salgado
authors.forename: Carla C
authors.initials: CC
authors.lastname: Romano
authors.forename: Maria das Graças Adelino
authors.initials: Md
authors.lastname: Alkmin
authors.forename: Alberto J S
authors.initials: AJ
authors.lastname: Duarte
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Seguro
mesh_terms: D000328:Adult; D006801:Humans; D011695:IgA Vasculitis / Q000276:immunology / Q000382:microbiology* / Q000473:pathology; D008297:Male; D008585:Meningitis, Meningococcal / Q000097:blood / Q000134:cerebrospinal fluid / Q000473:pathology*; D009345:Neisseria meningitidis / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000379:methods