Early-onset compartment syndrome of the limbs, a rare complication of meningococcal septicemia in infants?

Meningococcal (Neisseria meningitides) septicemia is a feared diagnosis in febrile infants presenting with a petechial rash. Despite a good susceptibility to penicillin which usually results in an assumed bacterial clearance from blood cultures early on; extensive organ damage often mandates a prolonged period of aggressive supportive therapy. In this context, overall outcomes can dependent on specific, organ-related complications and thus should be anticipated. In the reported case, a rare sudden occurrence of early-onset compartment syndrome of all extremities highlights muscle ischemia as a possible cause of unresponsiveness to intensive care treatment despite assumed bacterial clearance. Among other conclusions, the presented case mandates a close monitoring of both clinical and laboratory features of muscle damage as a standard measure of care designed to trigger emergency surgical decision making. Most importantly, we anticipate a likely significant improvement of long-term outcomes based on the notion of meningococcal sepsis-induced compartment syndrome in infants being an under-diagnosed entity.