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Primary (isolated) meningococcal pericarditis
David R Morgan1, Mark Spence, Mary Crowe
1Department of Cardiology, Belfast City Hospital, Northern Ireland, UK.
Abstract:
A 19-year-old man was admitted with a history and examination findings of probable bacterial pericarditis. Blood cultures produced Neisseria meningitidis Group C, sensitive to penicillin. The patient was initially treated with intravenous benzylpenicillin. Echocardiogram demonstrated the development of a pericardial effusion which was tapped, and benzylpenicillin was instilled into the pericardial space. Because of failure of clinical resolution, cefotaxime was substituted for benzylpenicillin. Rapid clinical improvement then ensued. Repeat echocardiogram showed evidence of neither reaccumulation nor constrictive pericarditis. Primary (isolated) meningococcal pericarditis is a recognized though rare manifestation of meningococcal disease. It is most common in young adults and is associated with a good prognosis.
Insights
A rare case of bacterial pericarditis caused by Neisseria meningitidis Group C in a young adult was successfully treated with cefotaxime after initial benzylpenicillin failure. This highlights a good prognosis for isolated meningococcal pericarditis.
Area of Science:
- Infectious Diseases
- Cardiology
Background:
- Bacterial pericarditis is a serious condition requiring prompt diagnosis and treatment.
- Neisseria meningitidis, a common cause of meningitis, can rarely manifest as isolated pericarditis.
Observation:
- A 19-year-old male presented with symptoms suggestive of bacterial pericarditis.
- Blood cultures identified Neisseria meningitidis Group C, susceptible to penicillin.
- Initial treatment with intravenous benzylpenicillin and pericardial instillation failed to resolve the condition.
Findings:
- Substitution of benzylpenicillin with cefotaxime led to rapid clinical improvement.
- Echocardiography confirmed resolution of pericardial effusion and no signs of constrictive pericarditis.
- Primary meningococcal pericarditis, though rare, is a recognized entity with a favorable outcome.
Implications:
- Cefotaxime may be a crucial alternative antibiotic in refractory meningococcal pericarditis.
- Early recognition and appropriate management are key for favorable outcomes in meningococcal pericarditis.
- This case underscores the importance of considering diverse presentations of Neisseria meningitidis infections.