A Case of Meningococcal Pericarditis Uncommon Complication of Purpura Fulminans

1.      Purulent pericarditis – due to direct bacterial invasion

2.      Immunologic pericarditis – due to immune-mediated inflammation

3.      Chronic constrictive pericarditis – a late sequela

Although Neisseria meningitidis commonly presents with meningitis or septicemia, cardiac involvement is rare. Purpura fulminans, characterized by rapidly progressive cutaneous hemorrhagic necrosis, indicates severe sepsis and carries a high mortality risk.

On examination:

·         BP: 80/50 mmHg, HR: 120 bpm

·         Extensive purpura over lower limbs and trunk

·         Muffled heart sounds and distended neck veins

·         Signs of septic shock

Investigations:

·         CBC: Leukocytosis with neutrophilia

·         Coagulation profile: Prolonged PT and aPTT, low fibrinogen

·         Blood cultures: Neisseria meningitidis serogroup C

·         Echocardiography: Large pericardial effusion with early tamponade features

·         Skin biopsy: Dermal vessel thrombosis with fibrin deposition (consistent with purpura fulminans)