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[Subacute meningococcaemia during adalimumab therapy].

N Salinas¹, M Etienne¹, A-M Roguedas¹

¹Dermatologie, CHRU de Brest, 2, avenue Foch, 29200 Brest, France.

Annales De Dermatologie Et De Venereologie

|October 26, 2019

Summary

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.

Keywords:

Adalimumab Méningococcémie subaiguë Neisseria meningitidis Subacute meningococcaemia

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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.