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Am. J. Trop. Med. Hyg., 77(4), 2007, pp. 723-726
Copyright © 2007 by The American Society of Tropical Medicine and Hygiene

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SHORT REPORT


Severe Myalgia of the Lower Extremities as the First Clinical Feature of Meningococcal Purpura Fulminans

Alexandre Leite de Souza*, Jaques Sztajnbok, Maristela Marques Salgado, Carla C. Romano, Maria das Graças Adelino Alkmin, Alberto J. S. Duarte, AND Antonio Carlos Seguro
Intensive Care Unit, Emílio Ribas Institute of Infectology, São Paulo, Brazil; Department of Immunology, Immunology and Microbiology Service, Adolfo Lutz Institute, São Paulo, Brazil; Department of Dermatology/LIM56, University of São Paulo School of Medicine, São Paulo, Brazil; Laboratory Head, Department of Nephrology, Laboratory of Basic Research, University of São Paulo School of Medicine, São Paulo, Brazil

 

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.

Received November 29, 2006. Accepted for publication January 23, 2007.

* Address correspondence to Alexandre Leite de Souza, Rua da Consolação, 2270 Ap 304, CEP 01302-001 São Paulo, SP, Brazil. E-mail: alexandre{at}emilioribas.sp.gov.br/alexandrelsouza{at}gmail.com

Authors’ addresses: Alexandre Leite de Souza, Rua da Consolação, 2270 Ap 304, CEP 01302-001 São Paulo, SP, Brazil. E-mail: alexandre{at}emilioribas.sp.gov.br/alexandrelsouza{at}gmail.com. Jaques Sztajnbok and Antonio Carlos Seguro, Av. Dr. Arnaldo, 455, Terceiro Andar, Sala 3310, São Paulo, Brazil, 01246-903. Maristela Marques Salgado and Maria das Graças Adelino Alkmin, Av. Dr. Arnaldo, 355, 11° andar, São Paulo, Brazil, 01246-902. Carla C. Romano and Alberto J.S. Duarte, Avenue Dr. Eneas de Carvalho Aguiar 500, 3° andar, São Paulo, Brazil.






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Copyright © 2007 by the American Society of Tropical Medicine and Hygiene.