Chronic meningococcemia occurred in a 2\ x =r eq-\ year-old boy. As in adults, the clinical constellation in childhood include a prolonged period of variable rash, fever, and arthritis accompanied by surprisingly little systemic toxicity. Because of its rarity and nonspecific symptomatology, this entity is frequently mistaken for a wide range of other infectious diseases, vasculitides, and collagenoses. Thus, the positive blood culture remains the diagnostic sine qua non. Although the pathophysiology of this peculiar host-bacterial interaction has not been elucidated, it may prove fruitful to consider the clinical features as results of immune-complex deposition rather than direct bacterial invasion.Chronic meningococcemia is a rare, or at least infrequently reported, clinical entity. Since Salomon1 first described the disease in 1902, there have been approximately 150 cases reported in the American literature, and only 12 have concerned patients less than 16 years old. Within the past decade, to the best of our knowledge, only five cases have been reported-a situation attributed by some2 to the indiscriminate use of antimicrobic agents in cases of unexplained fever.As defined by Dock,' this disease in¬ cludes "only those cases (of meningo¬ coccal septicemia) in which there is a febrile period of at least a week, with¬ out meningeal symptoms and whose clinical course changed abruptly if meningitis supervened." Others4 have contended that three days of bactere¬ mia without evidence of meningeal involvement is sufficient to warrant a diagnosis of chronic meningococ¬ cemia. The classical clinical constel¬ lation of intermittent or sustained fevers associated with recurring maculopapular, nodular, or petechial eruptions and migratory arthritis or arthralgias pertains in children as well as in adults. The case reported below is typical in its clinical charac¬ teristics and reflects the historical difficulty in distinguishing this dis¬ ease from a variety of other entities without the use of blood cultures. Al¬ though sequential, positive blood cul¬ tures are not available in this case, the clinical course indicates that men¬ ingococcemia was present over a pe¬ riod of at least five days.
Report of a CaseHistory.-A 2-year-old white boy was brought to the pediatrie clinic at US Army Hospital, Fort Devens, Mass, on April 20, 1971, with a 36-hour history of fever to 40 C and hives on the lower extremities, and with a six-hour history of refusal to walk. During the previous 24 hours, the erup¬ tions had become purpuric. He had had no abdominal pain or hematuria. Past history was unremarkable except for a mild cold three weeks prior to this visit. There was no history of atopy, infectious-toxic expo¬ sures, or drug ingestion. No recent cases of meningococcal infection had occurred on the post. Physical Examination.-Temperature was 38.3 C; blood pressure, 115/60 mm Hg; pulse rate, 120 beats per minute; and respi¬ rations, 28 per minute. The patient was ill, did not appear to be in a toxic condi¬ tion, and he was uncomfortabl...
