每日一题_2023.02.13

A 45-year-old man comes to the physician with a three-day history of a temperature of 39°C (102.2°F). He also complains of headache, neck stiffness, and a maculopapular rash on his trunk. A diagnosis of meningitis is made, and a smear and culture of his cerebrospinal fluid reveal a gram-negative diplococcus as the causative agent. Which of the following symptoms can develop as a severe complication of this infection?

一名45岁男性因体温39℃(102.2℉)3天就诊。患者还主诉头痛、颈部僵硬和躯干斑丘疹。诊断为脑膜炎，他的脑脊液涂片和培养显示革兰阴性双球菌是病原体。下列哪一种症状可作为这种感染的严重并发症出现?

(A)  Acute renal failure and thrombocytopenia with hemolytic anemia 急性肾衰竭和血小板减少伴溶血性贫血

(B)  Fever, migratory polyarthritis, and carditis 发热、游走性多关节炎和心肌炎

(C)  Fever, new murmur, small erythematous lesions on the palms, and splinter hemorrhages on the nail bed 发热，新发杂音，手掌小红斑，甲床碎裂出血

(D)  Shock, widespread purpura, disseminated intravascular coagulation, and adrenal in- sufficiency 休克、广泛紫癜、弥散性血管内凝血和肾上腺功能不全

(E)  Symmetric ascending muscle weakness beginning in the distal lower extremities 对称性上行性肌无力始于下肢远端

答案解析：

根据革兰染色结果，这种情况下的病原体是脑膜炎奈瑟菌。Waterhouse-Friderichsen综合征可能是脑膜炎球菌血症的一种并发症。在这种疾病中，双侧出血进入肾上腺引起肾上腺功能不全。这会导致低血压、心动过速、迅速增大的点状皮肤病变、弥散性血管内凝血和昏迷。

正确答案：D