ABSTRACT
IMPORTANCE: Although chronic meningococcemia is an uncommon disorder, it is of great importance to clinicians across multiple disciplines because it presents similarly to reactive, neoplastic, or rheumatic disorders. Ruling out chronic meningococcemia, however, represents a diagnostic challenge because routine microbiological investigations frequently fail to identify Neisseria meningitidis. Although treatment with corticosteroids might be helpful in various conditions, corticosteroid treatment may lead to severe complications in underlying chronic meningococcemia. OBSERVATIONS: We describe a patient with a history of recurrent fever, arthralgia, and disseminated skin lesions. The patient was assumed to have Sweet syndrome and was treated with corticosteroids. Subsequently the patient developed meningococcal meningitis and was admitted to the neurointensive care unit. Chronic meningococcemia was confirmed retrospectively by nonroutine polymerase chain reaction and silver staining of skin biopsy specimens. Immunologic workup revealed decreased IgG subclass 3. CONCLUSIONS AND RELEVANCE: Consideration of chronic meningococcemia is important when a patient presents with a history of fever and disseminated skin lesions. Polymerase chain reaction testing of skin biopsy specimens should be performed more systematically if the results of routine microbiological investigations remain unrevealing. In addition, silver staining of skin lesions can help establish the diagnosis. Eventually, testing for immune deficiencies should more routinely follow a confirmed diagnosis of chronic meningococcemia.
Subject(s)
Adrenal Cortex Hormones/adverse effects , Bacteremia/diagnosis , Diagnostic Errors , Meningitis, Meningococcal/chemically induced , Meningitis, Meningococcal/diagnosis , Sweet Syndrome/diagnosis , Adult , Bacteremia/complications , Chronic Disease , Diagnosis, Differential , Humans , Male , Sweet Syndrome/drug therapyABSTRACT
We present a case of chronic meningococcemia in a 27-year-old male with seven weeks of cyclic fever, arthralgia, and exanthema. While numerous blood cultures were negative, immunosuppressive treatment led to acute meningitis, and Neisseria meningitidis was detected. Serial meningococcal antibody tests were retrospectively analyzed and showed discrete seroconversion. Chronic meningococcemia is important to recognize since it can lead to acute meningitis in immunosuppressed or untreated patients resulting in high morbidity and mortality.
Subject(s)
Glucocorticoids/adverse effects , Meningitis, Meningococcal/chemically induced , Meningococcal Infections/diagnosis , Prednisolone/adverse effects , Acute Disease , Adult , Chronic Disease , Diagnosis, Differential , Glucocorticoids/administration & dosage , Humans , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Male , Meningococcal Infections/microbiology , Meningococcal Infections/pathology , Neisseria meningitidis/isolation & purification , Prednisolone/administration & dosageABSTRACT
We report an atypical presentation of meningitis due to Neisseria meningitidis in a patient who received large doses of ibuprofen. Anti-inflammatory therapy such as NSAIDs could reduce CSF inflammation and modify the clinical outcome in patients with bacterial meningitis. However, the use of NSAIDs is not recommended in bacterial meningitis due to a lack of studies.
