ro13-9904 and Purpura

Topics: Ceftriaxone; Child; Child, Preschool; Diagnosis, Differential; Exanthema; Female; Humans; Male; Meningococcal Infections; Physical Examination; Practice Guidelines as Topic; Purpura; Recurrence; Risk Assessment; Severity of Illness Index

Our patient's signs and symptoms developed one week after being bitten by a rat that she was feeding to her son's pet snake.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Arthralgia; Ceftriaxone; Dyspnea; Female; Fever; Humans; Middle Aged; Purpura; Rat-Bite Fever; Rats

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Subacute Bacterial; Erythema; Gentamicins; Humans; Male; Purpura; Treatment Outcome; Vancomycin; Young Adult

A young woman was examined in the Emergency Department for fever, pharyngitis and widespread petechial rash. Physical examination, including neurological evaluation, did not show any other abnormalities. Chest X-ray was negative. Blood exams showed leukocytosis and CPR 20 mg/dL (nv<0.5 mg/dL). On the basis of these results and petechial rash evidence, lumbar puncture was performed. CSF was opalescent; physico-chemical examination showed: total proteins 2.8 (nv 0.15-0.45), glucose 5 (nv 59-80), WBC 7600/μL (nv 0-4/ μL). In the hypothesis of meningococcal meningitis, antimicrobial therapy was started. Blood and cerebrospinal fluid cultures were positive for N. meningitidis. During the first hours the patient experienced hallucinations and mild psychomotor agitation, making a spontaneous recovery. A brain MRI showed minimal extra-axial inflammatory exudates. She was discharged after 10 days in good condition. We underline the need to consider meningococcal meningitis diagnosis when any suggestive symptom or sign is present, even in the absence of the classic meningitis triad, to obtain earlier diagnosis and an improved prognosis.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Diffusion Magnetic Resonance Imaging; Fever; Hallucinations; Humans; Immunocompetence; Meningitis, Meningococcal; Neisseria meningitidis; Neuroimaging; Pharyngitis; Psychomotor Agitation; Purpura; Spinal Puncture

We describe the case of a 70-year-old woman who presented with symptoms of cardiac failure, and was found on clinical examination to have a purpuric rash over her lower extremities. Further evaluation of cardiac failure revealed tricuspid regurgitation with two large tricuspid valve vegetations. Blood cultures yielded a growth of Streptococcus viridans. She was treated with an intravenous ceftriaxone and gentamicin and made a complete recovery with resolution of the rash.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Female; Gentamicins; Heart Failure; Humans; Purpura; Streptococcal Infections; Tricuspid Valve; Viridans Streptococci

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Bacteremia; Ceftriaxone; Humans; Hydrocortisone; Male; Meningococcal Infections; Middle Aged; Neisseria meningitidis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Protein C; Purpura; Recombinant Proteins; Vancomycin

Topics: Acute Disease; Adult; Bacteremia; Ceftriaxone; Female; Humans; Meningitis, Meningococcal; Neisseria meningitidis; Purpura; Skin Diseases; Vasculitis