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Unusual presentation of meningococcal meningitis in the elderly and utility of CSF PCR testing
Elizabeth Ranson1, Hannah Ship1, Omai Garner2
1Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, USA.
Abstract:
We present an unusual case of a previously healthy 74-year-old man who presented with diffuse weakness, severe myalgias, petechial palmar rash and hypotension, but without fever, altered mental status, nuchal rigidity or headache, who was ultimately found through PCR testing to have meningococcal meningitis.
Insights
A previously healthy 74-year-old man developed severe symptoms including weakness, myalgias, and a petechial rash. He was diagnosed with meningococcal meningitis via PCR testing, despite lacking typical signs like fever or headache.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Meningococcal meningitis typically presents with fever, headache, and nuchal rigidity.
- Atypical presentations can delay diagnosis and treatment, potentially leading to severe outcomes.
Observation:
- A 74-year-old man with no prior health issues presented with diffuse weakness, severe myalgias, petechial palmar rash, and hypotension.
- The patient notably lacked fever, altered mental status, nuchal rigidity, or headache, confounding initial diagnostic considerations.
Findings:
- Polymerase chain reaction (PCR) testing confirmed the presence of Neisseria meningitidis, establishing the diagnosis of meningococcal meningitis.
- The clinical presentation was highly unusual, deviating significantly from the classic signs and symptoms of meningococcal meningitis.
Implications:
- This case highlights the importance of considering meningococcal meningitis even in the absence of classic symptoms, particularly in older adults.
- Early and accurate diagnosis through appropriate testing is crucial for timely intervention and improved patient outcomes in atypical meningitis cases.
- Further research into variations in meningococcal meningitis presentation may improve diagnostic strategies and patient management protocols.
