[Septic arthritis of the knee by Neisseria meningitidis serogroup W-135: First case reported in adults]

Atypical presentation of invasive meningococcal disease caused by serogroup W meningococci

Neisseria meningitidis, a gram-negative diplococcus, is typically an asymptomatic coloniser of the oropharynx and nasopharynx. Passage of N. meningitidis into the bloodstream can cause invasive meningococcal disease (IMD), a potentially life-threatening illness with rapid onset that generally presents as meningitis, septicemia or both. Serogroup W IMD has been increasing in prevalence in recent years, and observations suggest that it may present with atypical signs and symptoms. Herein, a literature search was performed to identify trends in atypical serogroup W IMD presentation in order to review those that are most prevalent. Findings indicate that the most prevalent atypical presentations of serogroup W IMD include acute gastrointestinal (GI) symptoms, septic arthritis and bacteremic pneumonia or severe upper respiratory tract infection, notably epiglottitis. Atypical clinical presentation is associated with higher case fatality rates and can lead to misdiagnoses. Such risks highlight the need for clinicians to consider IMD in their differential diagnoses of patients with acute GI symptoms, septic arthritis or bacteremic pneumonia, primarily in regions where serogroup W is prevalent.

Child with serogroup W135 primary meningococcal septic arthritis

Over the last decade, there has been a concerning increase in the number of invasive meningococcal serotype W infections in Europe. Although sepsis and meningitis are the most feared complications, focal complications of systemic disease such as pneumonia, pericarditis and arthritis can also occur. We present a rare case of isolated meningococcal W135 arthritis of the hip without invasive meningococcal disease in a 6-year-old patient.

Primary meningococcal septic arthritis with multiple native joint involvement

A previously healthy 18-year-old woman presented with an acutely painful, swollen right ankle joint, with similar symptoms subsequently developing in the right hip and right wrist. Microbiological samples from the ankle aspirate grew Neisseria meningitidis She had had no preceding clinical symptoms of meningitis or previous contact with a patient with meningitis. She was treated with intravenous antibiotics and surgical drainage.On follow-up, her symptoms had resolved, inflammatory markers had returned to normal and she has no long-term sequelae of septic arthritis. Primary meningococcal septic arthritis in the adult population is extremely uncommon, and makes up approximately 1% of all cases of primary septic arthritis.

Meningococcal arthritis and myopericarditis: a case report

Background

We 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 presentation

A 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).

Conclusions

We 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 material

The online version of this article (10.1186/s12879-017-2845-3) contains supplementary material, which is available to authorized users.