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PCR-positive meningococcal CSF infection without pleocytosis but high IL-6 and IL-8
Susanne Dyckhoff-Shen1, Hans-Walter Pfister2, Uwe Koedel2
1Department of Neurology with Friedrich-Baur-Institute, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. susanne.dyckhoff@med.uni-muenchen.de.
Background:
Meningococcal meningitis is still a severe disease causing high mortality and morbidity rates. Early diagnosis is crucial to ensure prompt antibiotic therapy. However, identification of the pathogen can be challenging.
Case Presentation:
A 32-year-old male patient with systemic lupus erythematosus (SLE) presented to the emergency room with fever, nausea, vomiting, headache and lower back pain as well as multiple petechial bleedings. On suspicion of meningococcal infection, the emergency doctor had already administered one dose of ceftriaxone before arrival to the clinic. Blood works showed massive inflammation due to bacterial infection. Cerebrospinal fluid (CSF) analysis showed normal cell count, protein and glucose levels but PCR was positive for Neisseria meningitis and IL-6 as well as IL-8 were elevated. On antibiotic therapy with ceftriaxone, the patient's condition improved quickly.
Conclusions:
We present a rare case of meningococcal infection of the CSF in a SLE patient without further CSF abnormalities. We discuss the involvement of early antibiotic treatment and the role of the patient's immune status in the normal CSF findings of this case. Moreover, this case demonstrates the importance of early antibiotic therapy in bacterial meningitis for the clinical outcome.
Insights
Early antibiotic treatment rapidly improved a patient with meningococcal meningitis and systemic lupus erythematosus (SLE), despite normal cerebrospinal fluid (CSF) findings. This highlights the importance of prompt intervention in bacterial meningitis.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Meningococcal meningitis remains a significant global health concern, characterized by high mortality and morbidity rates.
- Prompt diagnosis and initiation of antibiotic therapy are critical for improving patient outcomes.
- Accurate identification of Neisseria meningitidis can be diagnostically challenging.
Observation:
- A 32-year-old male with systemic lupus erythematosus (SLE) presented with symptoms suggestive of meningococcal infection, including fever, headache, and petechial hemorrhages.
- Initial cerebrospinal fluid (CSF) analysis revealed normal cell counts, protein, and glucose levels.
- Despite normal CSF parameters, PCR confirmed Neisseria meningitidis, with elevated Interleukin-6 (IL-6) and IL-8 levels.
Findings:
- The patient received an initial dose of ceftriaxone prior to hospital arrival, leading to rapid clinical improvement.
- The case highlights a rare instance of meningococcal meningitis in an SLE patient presenting with unremarkable CSF.
- Elevated inflammatory markers (IL-6, IL-8) were observed alongside the confirmed bacterial presence.
Implications:
- This case underscores the critical role of early antibiotic administration in managing bacterial meningitis, even in the presence of seemingly normal CSF.
- The patient's underlying immune status (SLE) may have influenced the CSF findings, warranting further investigation.
- Timely intervention with antibiotics is paramount for favorable clinical outcomes in meningococcal infections.
