0071643192.pdf

DERMATOLOGY

■ Multiple lesions around the periarticular areas of the extremities, beginning

as tender erythematous or hemorrhagic papules that change into pustules

and vesicles with an erythematous halo, which then scab over in 4–5 days.

■ Gonococcal tenosynovitis primarily affects larger joints (knees, elbows,

wrists, ankles, and hands).

DIAGNOSIS/TREATMENT

■ Often treated in ED based on clinical findings

■ Ceftriaxone 125 mg IM for uncomplicated disease, 250 mg IM for PID,

and 1 g IV q day ×10 days for disseminated infection; see Chapters 8 and

12 for details

MENINGOCOCCEMIA

ETIOLOGY

■ Neisseria meningitides

■ Affects primarily young children and young adults

SYMPTOMS/EXAM

■ Fever, severe HA, AMS, N/V, arthalgias, stiff neck and rash

■ The classic rash is petechiae found on the trunk, extremities, palms, soles,

and mucous membranes (see Figure 17.8).

■ It evolves into angulated purpuric papules, patches and plaques with gray

necrotic centers, a pathognomonic finding for meningococcal infection.

■ Fulminant meningococcal disease presents with sudden prostration,

petechiae with large areas of ecchymosis and shock, and can be compli-

cated by purpura fulminans, a severe form of DIC.

TREATMENT

■ Vancomycin and ceftriaxone

■ All household contacts, day-care contacts, and exposed hospital personnel

should receive prophylactic antibiotic treatment with rifampin.

FIGURE 17.8. Meningococcemia. Early findings include petechiae evolving into a

purpuric lesion.

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Emergency

Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:1519.)

Waterhouse-Friderichsen

syndrome is acute adrenal

insufficiencycaused by

hemorrhage in patients with

meningococcemia.

Ill-appearing + petechiae =

ceftriaxone and vancomycin.

Other diseases may cause

this, but meningococcemia is

at the top of the list.