Thrombolytic therapy in adult meningococcal purpura fulminans with acute renal failure and severe perfusion deficits to the extremities.

OBJECTIVE

To investigate whether systemic administration of recombinant tissue plasminogen activator would improve organ perfusion in an adult patient with fulminant meningococcal disease.

DESIGN

Descriptive case report.

PATIENT: A 45-year-old female with meningococcal septic shock, purpura fulminans and multiple organ failure who was treated in an eight-bed medical intensive care unit of a University hospital.

INTERVENTION: In addition to standard aggressive treatment, on each of three consecutive days the patient received recombinant tissue plasminogen activator infusions at a dose of 20 mg over 4 hrs.

RESULTS

Urine output was recorded before, during, and after the recombinant tissue plasminogen activator infusions. In addition, the patient's peripheral perfusion status was documented by clinical assessment. The patient showed a dramatic improvement in urine output, as well as a perceived increase in skin perfusion after recombinant tissue plasminogen activator therapy. The amount of exogenous vasopressor and inotropic support required to maintain the patient's hemodynamic status also rapidly decreased.

CONCLUSIONS

In this adult patient, recombinant tissue plasminogen activator therapy resulted in improved organ perfusion similar to that reported for paediatric patients. The findings indicate a need for controlled studies concerning the use of thrombolytics in severe meningococcal disease.