Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 26:8:23742895211043244.
doi: 10.1177/23742895211043244. eCollection 2021 Jan-Dec.

Educational Case: Neisseria Meningitis

Haley L Taylor  1 , Laurie L Wellman  1 , Richard M Conran  1
Affiliations

Educational Case: Neisseria Meningitis

Haley L Taylor et al. Acad Pathol. .

Abstract

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1.

Keywords: Waterhouse-Friderichsen syndrome; brain; central nervous system; disseminated intravascular coagulation; meningitis; nervous system; organ system pathology; pathology competencies.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Cerebrospinal fluid (CSF) gram stain reveals numerous neutrophils. The neutrophil at the arrow demonstrates several gram-negative diplococci within the cytoplasm, a feature consistent with Neisseria meningitidis infection. Republished with permission from web path (https://webpath.med.utah.edu/CNSHTML/CNS191.html).
Figure 2.
Figure 2.
A, Acute bacterial meningitis. Brain shows a prominent white exudate involving the leptomeninges most prominent over the frontal lobe, compared to the normal translucent leptomeninges covering the fixed brain in B.
Figure 3.
Figure 3.
A, The subarachnoid space in acute bacterial meningitis is distended by a prominent neutrophilic infiltrate (*) compared to the subarachnoid space (arrowhead) in the normal leptomeninges in B (hematoxylin and eosin [H&E], intermediate magnification).
Figure 4.
Figure 4.
The subarachnoid and perivascular (Virchow-Robin) space is distended with an acute inflammatory infiltrate. Brain parenchyma is not involved (hematoxylin and eosin [H&E], intermediate magnification).
Figure 5.
Figure 5.
A, Waterhouse-Friderichsen syndrome. Hemorrhage replaces the entire adrenal gland on cross section compared to the normal adrenal gland in B.
Figure 6.
Figure 6.
A, The adrenal gland shows hemorrhagic infarction of the adrenal cortex compared to the normal adrenal gland in B (hematoxylin and eosin [H&E], intermediate magnification). ZF indicates zona fasciculata; ZG, zona glomerulosa; ZR, zona reticularis.
See this image and copyright information in PMC

References

    1. Knollmann-Ritschel BEC, Regula DP, Borowitz MJ, Conran R, Prystowsky MB. Pathology competencies for medical education and educational cases. Acad Pathol. 2017;4. doi:10.1177/2374289517715040 - PMC - PubMed
    1. Chin-Hong PV, Guglielmo B. Infections of the central nervous system. In: Papadakis MA, McPhee SJ, Rabow MW, eds. Current Medical Diagnosis and Treatment 2020. McGraw-Hill; Accessed October 26, 2020. https://accessmedicine.mhmedical.com/content.aspx?.bookid=2683&sectionid...
    1. McGee S. Meninges. In: McGee S, ed. Evidence-Based Physical Diagnosis. 4th ed. Elsevier; 2018:221–226.
    1. Thomas KE, Hasbun R, Jekel J, Quagliarello VJ. The diagnostic accuracy of Kernig’s sign, Brudzinski’s sign, and nuchal rigidity in adults with suspected meningitis. Clin Infect Dis. 2002;35:46–52. - PubMed
    1. Kumar V, Abbas AK, Aster JC. Hemodynamic disorders, thromboembolic disease, and shock. In: Kumar V, Abbas AK, Aster JC, eds. Robbins and Cotran Pathologic Basis of Disease. 10th ed. Elsevier Saunders; 2021:125.