Macular, erythematous, nonpurpuric blanching lesions ranging from 2 to 15 mm in diameter are initially noted on the trunk and extremities. A typical petechial and purpuric eruption follows. Petechiae appear most commonly on the trunk and legs but may be found on other areas, including mucosal surfaces. They can coalesce to form larger reddish-purple intracutaneous hemorrhages, which occasionally become ulcerated. With the exception of occasional splenomegaly, the other abnormal physical findings are those associated with metastatic sites of infection.
Toxemia is profound.
Purpuric skin and mucosal lesions enlarge rapidly, and extensive intracutaneous hemorrhages may appear. Shock may be associated with a high cardiac output state and an effective decrease in the intravascular volume suggestive of endotoxemia, or it may be accompanied by congestive heart failure and a deterioration of cardiac output. The latter features may reflect myocarditis, which has been noted on histopathologic examination in more than 70 percent of patients with fatal meningococcemia. Shock is accompanied by disseminated intravascular coagulation of variable severity. Acute oliguric renal failure and adrenal hemorrhage may also develop, although bilateral adrenal hemorrhage is not the major cause of shock in patients with fulminant meningococcemia.