Primary Meningococcal Arthritis

Abstract

Meningitis and the clinical syndrome of acute meningococcemia are well-described sequelae from infections caused by Neisseria meningitidis. Within the realm of this syndrome, secondary sites of infection are not uncommon. There is a concomitant septic arthritis in 11% of cases of meningococcemia. 1 We describe below the rare clinical scenario of a 29-year-old woman with primary meningococcal arthritis without the clinical syndrome associated with meningococcemia. Case ReportA 29-year-old woman presented to the outpatient office with a chief complaint of an acutely painful and swollen left knee. On awaking that morning, she noted a decreased ability to flex and extend her left knee and extreme pain during ambulation. She had no medical or surgical history and was not on any medications. When doctors inquired about sexual contacts, she stated she had not been sexually active in the past 3 months. Three weeks before, she had a negative screening test for Neisseria gonorrhea and Chlamydia trachomatis during an annual gynecologic examination. She was afebrile and other vital signs were normal. She appeared to be well, but an erythematous, warm, swollen left knee that was diffusely tender to palpation was found. Active and passive range of motion was severely limited secondary to pain. An erythematous, macular rash was noted on the bilateral lower extremities. She was promptly transferred to the hospital with the diagnosis of septic arthritis.Orthopedic surgery consultation was obtained on arrival to the emergency department. Aspiration of the left knee yielded grossly purulent synovial fluid. It was sent for evaluation by Gram stain, culture, cell count, and crystal analysis. Serum laboratory testing for C-reactive protein, complete blood cell count, and 2 sets of blood cultures was performed (see Table 1). The patient was started on Vancomycin 1 g intravenously every 12 hours for Gram-positive bacteria, given the initial gram stain result. She was taken to the operating room for urgent arthroscopic incision, drainage, and lavage of the left knee. During transportation to the operating room, the patient developed pain in the left shoulder. Examination at that time revealed decreased range of motion secondary to pain. Arthrocentesis of the left shoulder, while the patient was under anesthesia, yielded grossly purulent fluid. Open incision and drainage of the left shoulder was performed, followed by arthroscopic incision and drainage of the left knee.On postoperative day 1, blood cultures and synovial fluid cultures collected from operative intervention revealed Gram-negative diplococci. Ceftriaxone 1 g intravenously every 24 hours was initiated for presumed gonococcal arthritis. Soon thereafter, the organisms were identified as Neisseria meningitides; vancomycin was discontinued. Two sets of blood cultures revealed N. meningitidis. The patient had fever of 102.9°F on postoperative day 2, but she remained stable and never showed signs or symptoms of meningitis or the clinical syndrome of meningococcemia during her hosp...

Primary meningococcal oligoarthritis of the knee—case report and review of the literature

“…Gram-negative enteric species such as Escherichia coli and Pseudomonas are much less common and affect mainly neonates and immunocompromised patients. While in younger sexually active adults, Neisseria gonorrhoea remains the most common gramnegative cause of bacterial arthritis [2]. Gonococcal disease, in decline since 1985, is again on the increase, which may in part be explained by escalating antibiotic resistance [3].…”

North American Primary Care Research Group President's Award

“…This issue's Brief Reports provide a reminder on primary meningococcal arthritis 22 and unique cases of clozapine-induced cardiomyopathy 23 and concurrent babesia and lyme disease after splenectomy. 24 This issue of the journal highlights exactly the type of information family medicine researchers are providing to influence practice.…”

Primary Meningococcal Arthritis Leading to Neisseria Meningitidies Purpura Fulminans

“…1 PMA is arthritis without meningitis, fever, rash, and hemodynamic instability. 2 It is usually preceded by an upper respiratory infection in 50-55% of presentations, and patients may appear nontoxic, afebrile, and polyarthralgic. Despite definition they may have a rash.…”