Fulminating meningococcemia and meningitis with vascular collapse; report of a case of Waterhouse-Friderichsen syndrome with recovery
Lerro, S.J.
United States Armed Forces Medical Journal 6(8): 1182-1192
1955
ISSN/ISBN: 0566-0777 PMID: 14397040 Document Number: 9011
Recovery of a 23-year-old man with fulminating meningococcemia and meningococcic menin gitis (Waterhous-Friderichsen syndrome of the encephalomyelitic type) is reported. Recovery from severe shock and circulatory collapse resulted after a period of 3 hours and 15 minutes. Massive initial doses of adrenal cortical extract intravenously and desoxycorticosterone acetate intramuscularly, in addition to sulfadiazine intravenously and crystalline penicillin intramuscularly, were employed. Excessive intravenous fluid and colloid therapy was avoided. Clinical evidence of hypopotassemia was supported by electrocardiographic changes and by a low level of serum potassium during the recovery phase. There was good response to the oral administration of potassium acetate, orange juice, and food. Acute arthritis of the right elbow developed on the eighth day of illness; conservative treatment was followed by complete recovery. No significant blood chemical changes or renal depression was noted during the course of the illness. A more favorable prognosis may now be given to this previously fatal syndrome with the early administration of adrenal cortical hormones, including cortisone, in addition to sulfadiazine and penicillin.
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