Bone lesions in a child with meningococcal meningitis and disseminated intravascular coagulation

Tochen, Mark L.

doi:10.1016/s0022-3476(77)80850-0

Cited by 10 publications

(3 citation statements)

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“…It â€˜¿ is known that meningococcic sepsis with intravascular coagulation may cause hemorrhage and necrosis in many organs; osteomyelitis and arthritis have also been described [3,4], but to our knowledge epiphysiometaphyseal changes similar to our cases have not been reported. Staphylococcus and other organisms may produce mul ticentric osteomyelitis, but local signs of infection, periosteal reaction, and sequestra are usually present [5].…”

Section: Discussionmentioning

confidence: 49%

Epiphysiometaphyseal changes in children after severe meningococcic sepsis

Fernandez¹,

Pueyo²,

Jiménez³

et al. 1981

American Journal of Roentgenology

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We studied three children with severe forms of meningo coccic sepsis and intravascular coagulation having exten sive cutaneous necrosis during their acute illness. After 1 year, two of them showed epiphysiometaphyseal abnormal ities limited to the lower limbs with bowing of the legs and secondary dwarfism. In the third case, bilateral abnonmali ties appeared 4 months after the sepsis and involved the distal tibia, fibula, and talus, as well as the left tansal navic ular. These lesions are extremely rare and to our knowledge have not been reported previously. Case ReportsCase 1 A 7-month-oldboywasadmittedbecauseof 5 hr of restlessness and high fever. He was pale and responded only to painful stimuli.His temperature was 39.5Â°C; blood pressure, 75/30 mm Hg; white blood cell count, 3,000/mm3; platelets, 30,000/mm3; prothrombin time, 32%; hemoglobin, 1 1 g/dl; and hematocnit, 33%. A spinal puncture showed cloudy cerebrospinalfluid with 70 cells/mm3, 60% of which were neutrophils. In stained smears and cultures, Neisseria meningitidis was isolated.At 2 hr after admission extensive ecchymosis and petechiae appeared and the patient went into shock, recovering after intensive therapy. During his hospital stay, extensive skin necrosis required grafts,as well as amputationof severalphalangesof both hands. Case 2A 9-month-oldboy was admittedafter 12 hr of high fever and obtundation.Petechiaebegan developing3 hr before admission and on admission he was in shock with extensive ecchymosis and petechiae. His liver was palpable 6 cm below the costal margin. His neck was supple. His temperature was 38.5Â°C;hemoglobin, 11.5 gm/dI; hematocrit, 36%; white blood cell count, 1,25O/mm3; plate lets, 30,000/mm3; and prothrombin time, 14%. His cerebrospinal fluid wascloudyandcontained25 cells/mm3,mostof themneutro phils. In smears and cultures Neisseria meningitidis was isolated.Duringhis hospitalcourse, the extensivecutaneousnecrosisre quired skin grafts and amputation of several phalanges of hands and feet.At 1Â½ years after dischargehe developedlimpingon the left. Case 3A 4-year-old girl was admitted aften 1 day of vomiting, lethargy, fever of 39Â°C, and pallor. On admissionshe had extensivepete chiae and nuchal rigidity. Her blood pressure was 70/40 mm Hg; white blood cell count, 3,000/mm3; platelets, 30,000/mm3; pro thnombin time, 32%; hemoglobin, 8.1 g/dI; and hematocrit, 27%.Her cerebrospinal fluid was cloudy and contained100 cells/mm3, most of them neutrophils. In stained smears and cultures, Neisseria meningitidis was isolated. During her hospital stay she had exten sive hemorrhagicnecrosisof the skin, affecting mainlythe lower extremities. She also had pain in both knees and ankles. Radio graphswereunremarkableat that time.At 4 months after discharge she was seen with flexion deformity of the right knee and talipes equinovarus deformity of the feet. Aadiography showed mild irregularities of the distal tibial epiphy siometaphyseabareas but there was necrosis of the lateral aspect of the talar domes( fig. 3). Necrosisof the lef...

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Section: Discussionmentioning

confidence: 49%

Epiphysiometaphyseal changes in children after severe meningococcic sepsis

Fernandez¹,

Pueyo²,

Jiménez³

et al. 1981

American Journal of Roentgenology

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“…Ein Infarkt der Phalangen und Metakarpalia bei Kindern (Sichelzellendaktylitis) schaut den Läsionen bei Postmeningokokkeninfektionen bei Kindern (endotoxische ShwartzmanReaktion) sehr ähnlich [115]. Eine vermehrte Freisetzung von zirkulierenden Endothelzellen bei der Sichelzellenkrise ist ein Zeichen von Gefäûzerstörungen.…”

Section: Hämoglobinopathienunclassified

Epidemiologische Risikofaktoren für die nichttraumatische Osteonekrose

Jones¹

2000

Orthopäde

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Certain fractures and/or dislocations of the femoral head are known to cause arterial injury and result in post-traumatic osteonecrosis. However, the more complex etiology of non-traumatic osteonecrosis is multifactorial and includes chemotherapy, radiotherapy, thermal injuries, and especially coagulopathies, which are now commonly observed in these patients. Intravascular coagulation with fibrin thrombosis begins in the capillaries and sinusoids of the intraosseous microcirculation, and residual venous thrombosis is more likely to occur if there is coexistent hypofibrinolysis. Coagulopathies are intermediary events, which are always activated by some underlying etiologic risk factor(s). Conditions capable of triggering intravascular coagulation include familial thrombophilia (resistance to activated protein C, decreased protein C, protein S, or antithrombin III, and hyperhomocystinemia), hyperlipemia and embolic lipid (alcoholism and hypercortisonism), hypersensitivity reactions (allograft organ rejection, immune complexes, and antiphospholipid antibodies), bacterial endotoxic (Shwartzman) reactions and various viral infections, proteolytic enzymes (pancreatitis), tissue factor release (inflammatory bowel disease, malignancies, neurotrauma, and pregnancy), and other thrombophilic and hypofibrinolytic disorders. Currently known risk factors for non-traumatic osteonecrosis of the femoral head are described briefly in this review article.

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“…During the course of DIC, the occlusion of small blood vessels by microthrombosis results in necrotic lesions of the skin, brain, kidneys, adrenals and other tissues from which result extensive cutaneous scars, cerebral lesions or limb amputations [3].…”

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confidence: 99%

Late osteoarticular lesions following meningococcemia with disseminated intravascular coagulation

et al. 1989

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Nineteen children, who had been admitted to the Pediatric Hospital of Coimbra with severe meningococcal infection with DIC, were submitted to clinical and radiological examination, an average of 4.2 years after hospitalization, in order to demonstrate late skeletal lesions. Patellar dystrophy, to our knowledge previously unreported, was found in 4 children, all of whom had overlying cutaneous scarring.

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Bone lesions in a child with meningococcal meningitis and disseminated intravascular coagulation

Cited by 10 publications

References 4 publications

Epiphysiometaphyseal changes in children after severe meningococcic sepsis

Epiphysiometaphyseal changes in children after severe meningococcic sepsis

Epidemiologische Risikofaktoren für die nichttraumatische Osteonekrose

Late osteoarticular lesions following meningococcemia with disseminated intravascular coagulation

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