[Unsuspected meningococcal disease]

Meningococcal disease has a wide spectrum of clinical presentation. Occult bacteremia is not easily diagnosed and may have good prognostic.

Three year-old African boy with fever, gonalgia and gait disorder with 24 hours of evolution. Observation was unremarkable. He presented leukocytosis (27,300/mL) with neutrophilia (21,000/mL) and elevated reactive C protein (10.8 mg/dl) with normal osteo-articular imagiologic exams. A blood culture was obtained and he was discharged with the probable diagnosis of hip synovitis. Two days later, he was asymptomatic without fever or blood infectious parameters although Neisseria meningitidis was identified in the blood culture. Ceftriaxone was given for seven days. Before starting this treatment a second blood culture was negative. There were no complications.

Meningococcal disease may present with fever without toxic appearance--unsuspected meningococcal disease--causing difficulty in the diagnosis and delaying the treatment. Spontaneous resolution is rare and severe complications may occur.