Medical Mystery of the Week

Because of the COVID19 pandemic, you are practicing medicine by telemedicine. You are presented a case of an 8-year-old previously healthy boy who presented with an acute onset illnes with fever, rigor, abdominal pain and hematochezia. On admission to the hospital his pulse was 110 and regular, respirations 20 per minute, temperature 38.5 degrees centigarde, and BP 90/60 mmHg. His image is provided below.

What is your diagnosis, what test(s) would you order to confirm your suspicions, and what treatment, if any, would you recommend?

DIAGNOSIS: Meningococcemia. Abdominal symptoms, which may include pain, emesis, and diarrhea, occur in about 10% of patients with menigococcemia.

Gross hematochezia, although rare, has also been reported . The clues to the diagnosis in the presented case is the young age, the occurrence in an otherwise healthy child, the fulminant course, the hypotension, and the hemorrhagic (petecial and purpuric) rash involving primarily the extremities and buttocks. Any patient with suspected meningococcemia should immediately be placed on IV antibiotics (penicillin is the drug of choice), since any delay can result in the occurrence of purpura fulminans, acral necrosis, and death.