[Meningococcal sepsis without cerebrospinal fluid abnormalities under treatment with eculizumab]

Area of Science:

• Infectious Diseases
• Hematology
• Immunology

Background:

• Neisseria meningitidis infections commonly present as meningitis and can be life-threatening.
• Paroxysmal nocturnal hemoglobinuria (PNH) is a rare blood disorder.
• Eculizumab is a complement inhibitor used to treat PNH.

Purpose of the Study:

• To report a case of meningococcal sepsis without meningitis in an adult patient with PNH treated with eculizumab.
• To highlight the potential for severe Neisseria meningitidis infection in immunocompromised patients.

Main Methods:

• Case report of a young woman with PNH on eculizumab therapy.
• Clinical presentation, diagnostic workup, and treatment are described.
• Blood cultures and cerebrospinal fluid analysis were performed.

Main Results:

• The patient presented with septic shock and positive blood cultures for Neisseria meningitidis.
• Cerebrospinal fluid analysis showed no evidence of bacterial meningitis.
• The patient had a history of meningococcal vaccinations.

Conclusions:

• Meningococcal sepsis can occur without typical meningitis signs in adults treated with eculizumab.
• Complement inhibition may increase susceptibility to invasive meningococcal disease.
• This case underscores the importance of vigilance for invasive infections in patients on complement inhibitors.