PMC4995527_01
Peripheral blood smear obtained upon presentation to the Emergency Department. Two pairs of diplococci are seen (red circle) phagocytosed within a macrophage. Pneumococcal antigen testing (antigen latex agglutination test) was then done and returned positive, while meningococcal antigen testing was negative.
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Since the Wright stain stains all bacteria blue, it was unclear if these diplococci were Gram-positive or Gram-negative (Fig. 1).
Bilateral adrenal glands were found on autopsy to have diffuse intra-parenchymal hemorrhage (dark brown areas), consistent with the Waterhouse-Friderichsen syndrome.
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Bilateral adrenal glands showed evidence of extensive hemorrhage, consistent with the Waterhouse-Friderichsen syndrome (Fig. 2).
Biopsy of the skin taken at autopsy shows evidence of diffuse intravascular coagulation (DIC) and microthrombi within peripheral vessels (black arrow), consistent with purpura fulminans.
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Skin histology was consistent with diffuse disseminated intravascular coagulation (DIC) and purpura fulminans (Fig. 3).