Disseminated intravascular coagulation in fulminant meningococcemia is most closely associated with infection by

• A. Acinetobacter sp.
• B. Moraxella sp.
• C. Neisseria gonorrhoeae
• D. Neisseria meningitidis

Answer: (D)

Massive activation of coagulation from endotoxin-driven inflammation during meningococcemia leads to disseminated intravascular coagulation. Neisseria meningitidis releases endotoxin that triggers a surge of inflammatory cytokines, causing widespread endothelial injury and tissue factor expression. This sets off the coagulation cascade throughout the microvasculature, consuming platelets and clotting factors and producing microthrombi and bleeding—hallmarks of DIC. The combination of meningococcemia with a purpuric rash or purpura fulminans is a classic setting for this DIC picture.

Neisseria meningitidis is the organism most closely linked to fulminant meningococcemia and its DIC because of this strong endotoxin-mediated inflammatory response. Other organisms can cause sepsis, but the dramatic DIC pattern described here is most characteristic of meningococcal infection.