MOF induced by meningococcal sepsis: Successful outcome after intensive multidisciplinary approaches

Dear editor Fulminant meningococcal sepsis (FMS) associated with Waterhouse-Friderichsen syndrome (WFS) is a life-threatening condition causing MOF and shock, which may eventually lead to death within hours. DIC is a part of the syndrome which is secondary to diffuse endothelial damage, vWF release and platelet activation. When sepsis is accompanied by a great increase in PMN count, release of lysosomal enzymes, mostly elastase, may activate coagulation pathways via mechanisms similar to those in promyelocytic leukaemia. Intensive plasma exchange (PEX) has been used for the management of FMS since the early 1980s [1–6]. Favourable results were reported by Church et al. [5] in 8 young patients aged 3 months to 16 years who were already predicted to have a very poor prognosis (mortality likelihood from 88 to 90%). Seven of these (75%), in fact, survived with improvement of all coagulation factors except