[Subacute meningococcaemia during adalimumab therapy]
N Salinas1, M Etienne1, A-M Roguedas1
1Dermatologie, CHRU de Brest, 2, avenue Foch, 29200 Brest, France.
Introduction:
Subacute or chronic meningococcaemia is an invasive infection by Neisseria meningitidis characterized by fever lasting between a few days (subacute) and a week or more (chronic), cutaneous rash and arthralgia, without meningitis.
Patients And Methods:
A 59-year-old woman was admitted for a fever with cutaneous rash. She had a history of Crohn's disease diagnosed in 2016 and treated with adalimumab for 14 months at a dosage of 40mg/week. For 3 days, she presented fever with a temperature of up to 40°C associated with a non-itchy erythematous-papular eruption on all four limbs, especially the lower limbs. The lesions were mildly painful on palpation. The rest of the clinical examination was unremarkable. The patient did not have arthralgia or neurological symptoms, and in particular, she exhibited no meningeal syndrome. Blood cultures as well as PCR on a skin biopsy specimen confirmed the diagnosis of meningococcaemia. The patient was treated with ceftriaxone 2g/day for 4 days then amoxicillin 12g/day for 4 days. A favourable outcome was quickly achieved, and the condition subsided without sequelae.
Discussion:
We report the first case of subacute meningococcaemia in a patient treated with anti-TNF alpha therapy. This case concerns the role of biotherapies, and more particularly anti-TNF alpha therapy, in the occurrence of particular infections but also in changes in their clinical presentation and clinical course, as in the present case without arthralgia.
Insights
Subacute meningococcaemia, a rare Neisseria meningitidis infection, presented atypically in a patient on anti-TNF alpha therapy. This case highlights altered clinical presentations of invasive infections during immunosuppressive treatment.
Area of Science:
- Infectious Diseases
- Immunology
- Dermatology
Background:
- Subacute or chronic meningococcaemia is an invasive Neisseria meningitidis infection characterized by prolonged fever, rash, and arthralgia, typically without meningitis.
- Anti-TNF alpha therapy, used for conditions like Crohn's disease, can increase susceptibility to opportunistic infections.
Observation:
- A 59-year-old woman with Crohn's disease on adalimumab (anti-TNF alpha) presented with fever and a widespread erythematous-papular rash.
- Clinical presentation lacked typical arthralgia and meningeal signs, deviating from classic meningococcaemia.
- Blood cultures and skin biopsy PCR confirmed Neisseria meningitidis, diagnosing meningococcaemia.
Findings:
- This is the first reported case of subacute meningococcaemia in a patient receiving anti-TNF alpha therapy.
- The patient experienced a favorable outcome with prompt antibiotic treatment (ceftriaxone and amoxicillin) without sequelae.
Implications:
- Biotherapies, particularly anti-TNF alpha agents, may influence the occurrence and clinical presentation of invasive infections.
- Clinicians should consider atypical presentations of meningococcaemia in immunocompromised patients.
- Understanding the impact of immunosuppressive therapies on infection dynamics is crucial for patient management.
