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

Alexandre Leite de Souza 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

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Jaques Sztajnbok 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

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Maristela Marques Salgado 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

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Carla C. Romano 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

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Maria das Graças Adelino Alkmin 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

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Alberto J. S. Duarte 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

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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

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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.

Author Notes

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