Osman YEŞİLBAŞ, Esra ŞEVKETOĞLU, Hasan Serdar KIHTIR, Nevin HATİPOĞLU, Hamdi Murat YILDIRIM, Canan Hasbal AKKUŞ

Beyin Apsesi ile Komplike olan Meningokoksemi Olgusu ve Güncel Yoğun Bakım Tedavi Yaklaşımları

Meningokoksemi Neisseria meningitidis' in etken olduğu peteşiyel purpura, sepsis, septik şok, çoklu organ yetmezliği ve gangren gibi ağır tablolara yol açan önemli bir enfeksiyon hastalığıdır. Altı yaşında kız hasta ateş, uykuya eğilim ve yaygın makülopapüler döküntü yakınmasıyla acil polikliniğine başvurdu. Ön tanı olarak meningokoksemik septik şok düşünülen hastaya seftriakson ve agresif sıvı tedavisi başlandı. Hastada tedaviye yanıtsız trombositopeni-ilişkili çoklu organ yetersizliği, hipotansiyon ve kanama diyatezi geliştiğinden sürekli veno-venöz hemofiltrasyon ve terapötik plazma değişimi uygulandı. Başvuru sırasında alınan kan kültüründe üreme saptanmayan hastanın serumunda multiplex polimeraz zincir reaksiyonu sonucu N. meningitidis serogrup W-135 saptandı. Dokuzuncu gününde konfüzyonu gelişen hastanın kraniyal manyetik rezonans görüntülemesinde sağ kapsüla interna komşuluğunda iskemi ve apse ile uyumlu lezyon görüldü. Meningokoksemide ekstremite amputasyonuna kadar ciddi sekellere yol açan iskemik infarkt olayının beyin gibi santral yerleşimli dokularda da görülebileceği ve enfekte olabileceği düşünülmektedir

A Case of Meningococcemia Complicated by Brain Abcess and Current Treatment Approches in Intensive Care Units

Meningococcemia, caused by Neisseria meningitidis, is an important etiology of purpura, sepsis, septic shock, multiorgan failure and gangrene. A six-year-old girl admitted to emergency department with fever, somnolence and diffuse maculopapular rash progressing into ecchymotic lesions. Meningococcemia with septic shock was the initial diagnosis; aggressive fluid therapy and ceftriaxone was started. She had thrombocytopeniaassociated multiple failure, bleeding diathesis and hypotension. Therapeutic plasma exchange and continuous veno-venous hemofiltration was applied to the patient. Multiplex polymerase chain reaction of serum sample was positive for N. meningitidis serogroup W135. On the 9th day, the patient suffered from confusion. Cranial magnetic resonance imaging showed a lesion near to capsula interna suggesting early ischemia and an abscess. Brain abscess is rare during meningococcemia, in which septic emboli leading to ischemia could play a role in pathogenesis. The cerebral lesion may be due to an event common with septic and ecchymotic skin involvement

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