Meningococcemia presenting as septic arthritis, pericarditis, and tenosynovitis

Immune complex associated complications in the subacute phase of meningococcal disease: incidence and literature review

AIM

To determine the incidence of immune complex associated complications (IAC) after severe meningococcal disease (SMD) in a group of Dutch children admitted to a paediatric intensive care unit (PICU).

METHODS

Retrospective chart analysis and follow up of 130 survivors of SMD admitted to PICU. Signs of IAC, inflammatory parameters, and temperature profile were reviewed.

RESULTS

Of 130 children with SMD, 20 (15.3%) showed one or more of the three manifestations of IAC: 18 (13.8%) developed arthritis (effusion, with or without erythema/arthralgia), 11 (8.4%) vasculitis, and five (3.8%) pleuritis. Eighteen of 20 (90%) patients with IAC had a secondary rise in temperature; in patients with no IAC this was 48 of 110 (43.6%). IAC was associated with leucocytosis in 82.3% versus 47.7% in patients without IAC, and with increased CRP in 86.6% versus 47.2% in patients without IAC. Leucocytes on admission were significantly lower in patients who would later develop IAC (mean 8.6 versus 13.8x10(9)/l).

CONCLUSION

IAC is a common complication of SMD, mainly occurring 4-10 days after systemic disease. IAC presents clinically as arthritis or vasculitis, mostly accompanied by secondary fever and raised inflammatory parameters.

Primary meningococcal arthritis associated with adult respiratory distress syndrome

A previously fit and well 20 year old man with primary meningococcal arthritis of the left knee is described. Despite intensive search there was no evidence of extra-articular meningococcal infection. He subsequently developed adult respiratory distress syndrome as a rare and previously undescribed complication.