To the Editor.
—I read with interest the Archives article by Fishbein et al entitled "Bacterial Meningitis in the Absence of CSF Pleocytosis" (1981;141:1369-1372). I recently have treated a patient with fulminant meningococcemia, the Waterhouse-Friderichsen syndrome, who indeed had a normal CSF cell count (one RBC per cubic millimeter), normal CSF protein and glucose levels, and a negative Gram's stain. After approximately 16 hours of growth on appropriate culture medium, however, the organism, eventually isolated as Neisseria meningitidis, was indeed growing. Results of the patient's blood cultures were also positive for the same organism isolated in the CSF.
Report of a Case.
—A previously healthy 29-year-old woman had malaise, myalgia, nausea, vomiting, and a nonspecific headache develop 24 hours before she was admitted to the Naval Hospital in Portsmouth, Va. She awoke on the day of hospital admission with painful purpuric lesions randomly distributed on all skin surfaces as well