Meningococcal arthritis and myopericarditis: a case report

Abstract

BackgroundWe report the first adult case of Neisseria meningitidis W-135 presenting with meningococcal arthritis and myopericarditis concomitantly, without other classical features of meningococcal disease.Case presentationA 67-year-old Caucasian man presented with acute-onset polyarthralgia, myalgia, and fever. On examination he had polyarticular synovitis. An electrocardiogram (ECG) demonstrated ST-elevation in leads I, II, III, aVF, and V2-V6 without reciprocal depression, and a high-sensitivity troponin level was significantly elevated. Cardiac magnetic resonance (CMR) imaging on day five of admission demonstrated patchy pericardial enhancement. Neisseria meningitidis W-135 was isolated from both synovial fluid and blood cultures. The clinical outcome was favourable with intravenous ceftriaxone and myopericarditis treatment (colchicine and ibuprofen).ConclusionsWe conclude that this is a rare case of disseminated Neisseria meningitidis W-135 presenting with acute polyarticular septic arthritis and myopericarditis, without other classical features of systemic meningococcal disease. The earlier described entity of primary meningococcal arthritis (PMA) can present in patients with meningococcal bacteraemia, and may not be distinct from disseminated meningococcal disease, but rather an atypical presentation of this.Electronic supplementary materialThe online version of this article (10.1186/s12879-017-2845-3) contains supplementary material, which is available to authorized users.

Primary meningococcal septic arthritis with multiple native joint involvement

“…As with more recognised forms of septic arthritis, the knee is the most commonly affected joint, but there have been two other reported cases in the literature of PMA originating in a native ankle joint 2 4. The most common causative serotype in adults is Group B,10 and to our knowledge, there have only been two other cases, in the adult population, caused by the Group W serotype 10 11. Although she had previously received the full programme of vaccinations against meningococcal disease, it has been reported that the efficacy of the meningococcal conjugate vaccine (MenACWY, covering the Group W serotype) decreases after the first year 12…”

Child with serogroup W135 primary meningococcal septic arthritis

“…PMSA is most often monoarthritic, affecting either the knee or ankle joint 16–20. It occurs in <3% of meningococcal infections.…”

“…Due to the alarming increase in the number of meningococcal W infections, it is important that physicians become more aware of unusual presentations of meningococcal disease such as PMSA. With prompt diagnosis and initiation of treatment, the prognosis is excellent 20…”