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396 CUTANEOUS LESIONS AND COMPLICATIONS IN ACUTE MENTNGOCOC-CAEMIA IN CHILDREN SURVIVING MENINGOCOCCAL SEPTIC SHOCK

Skin lesions are a presenting sign in fulminant meningococcal septic shock (FMSS). Maculopapular, petechial, ecchymotic lesions and purpura fulminans are related to disseminated intravascular coagulation following endotoxic shock. In order to gain insight into the presence, type, severity, localization, course, complications and follow-up of these skin manifestations in children who survived FMSS, a retrospective analysis of clinical records of 125 children presenting to the Academic Medical Centre with meningococcal infection (of which 52 with FMSS) was performed. Of the 87 children who survived, 23 patients suffered FMSS defined as persistent hypotension despite volume loading and/or signs of poor end-organ perfusion. Of these, 17 children had severe skin lesions. The lesions tended to be symmetrical and occurred frequently on the upper and lower extremities, thighs and buttocks. The management included intensive nursing care, debridements, necrotomy, skin grafting and amputations. The sequelae consisted of discolorations of the affected skin, multiple atrophic scan and in 4 patients amputations of digits, lower legs and/or arms were required. At present, a prospective study with a multidisciplinary protocol is designed to obtain additional immunological and coagulation parameters on the pathogenesis of the skin lesions and of the effect of treatment, in order to minimize the complications.