A CASE OF FULMINATING MENINGOCOCCEMIA EXHIBITING THE WATERHOUSE-FRIDERICHSEN SYNDROME AND DEMONSTRATING THE VALUE OF CORTICAL EXTRACT ADMINISTRATION

Abstract

A case of fulminating meningococcemia with recovery in a 17-yr.-old white girl exhibiting generalized focal ectodermal necrosis, massive gangrene of the lower extremities and bilateral ulnar nerve paralysis. The rest of the treatment remaining constant, withholding cortical extract resulted in marked hypotension and generalized somatic tremors which became maximal in 7-8 1/2 hrs. 10 ml. of cortical extract administered intravenously caused the blood pressure to begin to rise within the hr. with the disappearance of tremors. 5 ml. doses of cortical extract intramuscularly every 3 hrs. caused the blood pressure to return to the original level in 8-16 hrs. When alternated with desoxycorticosterone acetate the blood pressure was maintained at lower levels and somatic tremors were apparent. The tremors could not be correlated with low blood sugar or chlorides. Relative adrenal cortical insufficiency precipitated by toxemia and sepsis and aggravated by hemorrhagic ad-renalopathy was interpreted as the factor mainly responsible for the hypotension and somatic tremors. High fever with accelerated metabolic rate and resultant increased O2 requirement made manifest the latent adrenal cortical insufficiency.