A 2-year-old boy who, when presented in respiratory distress, was found to have purulent pericarditis with blood culture positive for Neisseria meningitidis. This represents the ninth reported case of meningococcal pericarditis in a child less than 14 years of age and is the first to be described in the absence of meningitis. P iraient pericarditis seldom af¬ flicts children, and only rarely is the meningococcus incriminated as the etiologic agent. In the eight re¬ ported cases in children under 14 years of age,1-8 meningitis invariably has been present with pericarditis usually occurring as a relatively late complication on the septicemia. The following is the report of a case in which meningococcal pericarditis ap¬ peared without meningitis in a child.Report of a Case A 2Vè-year-old Negro boy was first seen in the Harriet Lane Home Outpatient De¬ partment with a one-day history of illness; his mother's chief concerns were his grunt¬ ing respirations, lethargy, and continuous crying. In the examining room, he was alert and playful, despite mildly laborious respiratory efforts (grunting, retractions and flaring of the alae nasae). The rectal temperature was 37.4 C (99.3 F), the pulse rate 120 beats per minute, and the respira¬ tory rate 40 per minute. Nuchal rigidity was absent, and the lungs were clear to percussion and auscultation. The results of the remainder of the physical examination were within normal limits.A chest roentgenogram was read in the outpatient department as normal. Hematocrit reading was 34%; white blood cell count (WBC) was 7,500, with 31% juvenile forms, 47% polymorphonuclear cells, and 18% lymphocytes. He was observed over a six-hour period, seemed to improve clini¬ cally, and was sent home with instructions to return in the morning. The following morning the child was febrile to 38.3 C (100.9 F) and he appeared acutely ill; nuchal rigidity was prominent, and the child was irritable. Although rales were still absent, diminished breath sounds were noted at the right base. The abdomen was generally tender with de¬ creased bowel sounds on the right.Lumbar puncture produced clear, acellular cerebrospinal fluid with a glucose level of 62 mg/100 ml (serum glucose level, 106 mg/100 ml) and a protein level of 22 mg/100 ml. Gram stain did not reveal mi¬ croorganisms, and the fluid proved sterile on culture. Urine obtained by suprapubic puncture contained 1 to 2+ protein (spe¬ cific gravity of 1.022) with occasional red and white blood cells seen in each highpower field. The WBC was 11,600/cu mm with 58% juvenile forms. Serum chemistry values were as follows: blood urea nitro¬ gen, 29 mg/100 ml; standard bicarbonate, 15 mEq/liter; sodium, 126 mEq/liter; po¬ tassium, 4.9 mEq/liter; and chloride, 96 mEq/liter. A chest roentgenogram showed evidence of a right pleural effusion with enlargement of the heart since the previ¬ ous day. There was diffuse ST segment ele¬ vation in leads II, III, a VF, V,, and V" of the electrocardiogram, consistent with pericarditis.The child was admitted to the Childrens Med...