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Primary meningococcal arthritis requiring surgical drainage
Jimmy J Jiang1, Shuangqin Zhang, Jovito Angeles
1Department of Orthopaedic Surgery, University of Chicago Medical Center, Chicago, IL, USA.
Abstract:
Primary meningococcal arthritis (PMA) is a relatively rare diagnosis where the role of early surgical intervention for its treatment is not well defined. We report a case of PMA in a young otherwise healthy patient who developed polyarticular joint pain secondary to Niessieria meningitidis without systemic symptoms of meningitis or meningococcemia. He underwent a prolonged course of intravenous antibiotics and serial aspirations of his shoulder. However, symptoms in his shoulder did not improve and he later underwent surgical irrigation and debridement.Intraoperatively, the patient had no signs of articular damage to his right shoulder despite prolonged clinically symptomatic disease. Six weeks after surgery, he has regained normal strength and full range of motion without any deficits.Nonoperative management of PMA is frequently, but not invariably, successful. We report a patient with this diagnosis who ultimately needed surgical evacuation of his shoulder joint to achieve resolution of his symptoms.
Insights
Primary meningococcal arthritis (PMA) can be challenging to treat. This case highlights that while antibiotics are standard, surgical intervention may be necessary for persistent joint symptoms.
Area of Science:
- Rheumatology
- Infectious Diseases
- Orthopedic Surgery
Background:
- Primary meningococcal arthritis (PMA) is a rare condition.
- The optimal treatment strategy for PMA, particularly the role of early surgical intervention, remains undefined.
Observation:
- A young, healthy patient presented with polyarticular joint pain due to Neisseria meningitidis infection.
- The patient experienced persistent shoulder symptoms despite intravenous antibiotics and serial aspirations.
Findings:
- Surgical irrigation and debridement of the shoulder joint were performed.
- Post-surgery, the patient achieved full recovery with normal strength and range of motion.
- Intraoperative examination revealed no articular damage despite prolonged symptoms.
Implications:
- Nonoperative management of PMA is not always successful.
- This case suggests that surgical intervention may be crucial for resolving refractory PMA symptoms.
- Early consideration of surgical options could improve outcomes in select PMA cases.
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