A 19-year-old American youth suffered severe reactions after consuming the leftovers of a meal made of pasta and chicken, which resulted in the amputation of his limbs. The case was explained in the New England Journal of Medicine in 2021, but gained repercussions this week in the American press.
According to the report, the patient, who was not identified, ate the leftovers of a dish ordered the night before by his colleague with whom he shared the house – who would not have finished consuming it due to feeling unwell.
Upon eating the meal, the young man had abdominal pain and nausea followed by chills and vomiting, chest pains, stiffness of the neck, blurred vision, headaches and shortness of breath. He was taken to the hospital by his friend.
The symptoms started only after the meal, and the patient did not present any complaints in the 20 hours prior to the first hospitalization, according to the report.
In the emergency, the patient had good blood oxygenation, with a slight start in his heartbeat and blood pressure, in addition to pallor.
Transferred to another hospital, the young man began to manifest difficulty breathing and a drop in blood oxygenation rates.
Medicated and supported by oxygen, he was taken to a third hospital, where his systolic pressure dropped to 70 mm/Hg, and his pulse rate also dropped significantly.
From then on, the picture became even more complicated, when the American began to show purpuric eruptions all over his body. With new drugs administered, he was transferred by helicopter to a fourth hospital.
On his fourth admission, the doctors began pulling the history of the patient and his family members.
He had no known allergies and had had all required childhood immunizations. In the family history, it was found that her father had coronary artery disease, her mother had hypothyroidism and her brother had viral meningitis at 6 weeks of age.
Pavan K. Bendapudi, physician present on the case, reported that the progression of the case was rapid, including SIRS (systemic inflammatory response syndrome), which is characterized by fever, shock, severe lactic acidosis (lack of intracellular oxygenation and acid accumulation lactic acid in the bloodstream) and acute respiratory and renal failure.
“Perhaps the most striking features of this case were the profound coagulopathy [doença hemorrágica] and the rapid onset of the disease, with onset lasting less than 24 hours. Additional considerations were his young age and the absence of risk factors typically associated with sepsis (eg, a chronic illness or co-existing condition),” said Bendapudi.
The condition was related to infection by meningococcal bacteria NEW ENGLAND JOURNAL OF MEDICINE
Laboratory tests identified an infection by the bacterium N. meningitidis, and the diagnosis was purpura fulminans due to meningococcemia. Evolution led to tissue necrosis and forced the amputation of the young man’s legs below the knees, as well as his fingers.
According to the MSD Manual of Diagnosis and Treatment, purpura is a condition that causes small blood clots throughout the body that block blood flow to vital organs.
The medical guide also informs that “fulminant meningococcemia syndromes include Waterhouse-Friderichsen syndrome (sepsis, profound shock, cutaneous purpura and adrenal hemorrhage), sepsis with multiple organ failure, shock and disseminated intravascular coagulation”.
The manual points out that 10% to 20% of the patients who recover have serious sequelae, such as irreversible deafness, mental retardation, or loss of phalanges or extremities.
A 19-year-old American youth suffered severe reactions after consuming the leftovers of a meal made of pasta and chicken, which resulted in the amputation of his limbs. The case was explained in the New England Journal of Medicine in 2021, but gained repercussions this week in the American press.
According to the report, the patient, who was not identified, ate the leftovers of a dish ordered the night before by his colleague with whom he shared the house – who would not have finished consuming it due to feeling unwell.
Upon eating the meal, the young man had abdominal pain and nausea followed by chills and vomiting, chest pains, stiffness of the neck, blurred vision, headaches and shortness of breath. He was taken to the hospital by his friend.
The symptoms started only after the meal, and the patient did not present any complaints in the 20 hours prior to the first hospitalization, according to the report.
In the emergency, the patient had good blood oxygenation, with a slight start in his heartbeat and blood pressure, in addition to pallor.
Transferred to another hospital, the young man began to manifest difficulty breathing and a drop in blood oxygenation rates.
Medicated and supported by oxygen, he was taken to a third hospital, where his systolic pressure dropped to 70 mm/Hg, and his pulse rate also dropped significantly.
From then on, the picture became even more complicated, when the American began to show purpuric eruptions all over his body. With new drugs administered, he was transferred by helicopter to a fourth hospital.
On his fourth admission, the doctors began pulling the history of the patient and his family members.
He had no known allergies and had had all required childhood immunizations. In the family history, it was found that her father had coronary artery disease, her mother had hypothyroidism and her brother had viral meningitis at 6 weeks of age.
Pavan K. Bendapudi, physician present on the case, reported that the progression of the case was rapid, including SIRS (systemic inflammatory response syndrome), which is characterized by fever, shock, severe lactic acidosis (lack of intracellular oxygenation and acid accumulation lactic acid in the bloodstream) and acute respiratory and renal failure.
“Perhaps the most striking features of this case were the profound coagulopathy [doença hemorrágica] and the rapid onset of the disease, with onset lasting less than 24 hours. Additional considerations were his young age and the absence of risk factors typically associated with sepsis (eg, a chronic illness or co-existing condition),” said Bendapudi.
The condition was related to infection by meningococcal bacteria NEW ENGLAND JOURNAL OF MEDICINE
Laboratory tests identified an infection by the bacterium N. meningitidis, and the diagnosis was purpura fulminans due to meningococcemia. Evolution led to tissue necrosis and forced the amputation of the young man’s legs below the knees, as well as his fingers.
According to the MSD Manual of Diagnosis and Treatment, purpura is a condition that causes small blood clots throughout the body that block blood flow to vital organs.
The medical guide also informs that “fulminant meningococcemia syndromes include Waterhouse-Friderichsen syndrome (sepsis, profound shock, cutaneous purpura and adrenal hemorrhage), sepsis with multiple organ failure, shock and disseminated intravascular coagulation”.
The manual points out that 10% to 20% of the patients who recover have serious sequelae, such as irreversible deafness, mental retardation, or loss of phalanges or extremities.
