An Electron Miscroscope Study of a Case of Meningococcemia in Man

ONE OF THE characteristics of fulminant meningococcal septicemia is the rapid onset of irreversible shock and death. In addition to the fulminant clinical course the disease has been of interest because it is associated with two unusual lesions in a significant proportion of cases. These are the purpuric skin lesions and hemorrhagic adrenal necrosis. Adrenal hemorrhage was originally considered to be the cause of shock and death in meningococcemia but, with the failure of corticosteroid replacement therapy, circulatory failure cannot be ascribed to adrenal insufficiency.¹ In fact there may be no evidence of adrenal hemorrhage at postmortem examination, although the clinical course of the patient is characterized by irreversible shock. Ferguson and Chapman² have reviewed the necropsy findings in 16 cases of meningococcemia. They noted the presence of diffuse thromboembolic lesions in many organs including the heart, kidneys, liver, and lungs, as well as the adrenal glands and