(A) Disseminated gonococcal infection; (B) meningococcal infection
The early lesions in both gonococcemia and meningococcemia are often dermal infiltrated inflammatory papules with little pus or purpura. Mature lesions may develop varying degrees of purpura, pus, and ulceration.
The progression of the cutaneous lesions of disseminated gonococcemia is shown in Figures 1 and 2. The lesions are the result of septic emboli, and culture of a specimen from one will grow gonococci. As in the patients pictured here, the lesions of gonococcemia are usually acral, sparing the torso. Typically, only a few lesions are present. For more information on disseminated gonococcal infection, see “Sexually Transmitted Infections in Teens: Reading the Skin Signs,” by David S. Reitman, MD (CONSULTANT FOR PEDIATRICIANS, June 2009 special issue on dermatology, page S20).
The rash of meningococcemia, which usually begins as a petechial eruption, tends to become more ecchymotic and is characterized by large areas of ischemic necrosis. The rash typically develops on the trunk and lower extremities. Figures 3 and 4 show the meningococcal rash in its definitive stages. For more information on meningococcemia, see “Meningococcal Disease: Suspect It, Treat It, Prevent It,” by Sara J. Mola, MD, Linda S. Nield, MD, and Martin E. Weisse, MD (CONSULTANT FOR PEDIATRICIANS, April 2009, page 116).