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Meningococcemia presenting as acute polyarthritis
Abstract:
Four patientw with acute polyarthritis due to meningcoccemia are described. One had skin manifestations suggesting vasculitis, another had transient nodular lesions, but there were none of these features in the other two. Synovial fluid cultures were negative and cells counts did not suggest septic arthritis. The diagnosis was not suspected until positive blood cultures were reported in three cases and meningitis developed in the fourth. In spite of diagnostic delay due to slow growth in cultures (six to 11 days) there was prompt response to antibiotic treatment. Meningococcemia should be suspected in patients presenting with fever and polyarthritis, even in the absence of skin lesions.
Insights
Meningococcemia can cause acute polyarthritis, even without typical skin lesions. Early suspicion and prompt antibiotic treatment are crucial for favorable outcomes in patients with fever and joint pain.
Area of Science:
- Infectious Diseases
- Rheumatology
- Microbiology
Background:
- Meningococcemia, a serious bloodstream infection caused by Neisseria meningitidis, can present with diverse clinical manifestations.
- Acute polyarthritis is an uncommon but significant presentation of meningococcemia.
Observation:
- This study describes four patients with acute polyarthritis secondary to meningococcemia.
- Clinical presentations varied, with only two patients exhibiting skin manifestations (vasculitis or nodular lesions).
- Synovial fluid analysis did not indicate septic arthritis, delaying diagnosis.
Findings:
- Diagnosis was established through positive blood cultures in three patients and meningitis in the fourth.
- Despite diagnostic delays (6-11 days) due to slow bacterial growth, all patients responded promptly to antibiotic therapy.
- Meningococcemia should be considered in patients with fever and polyarthritis, irrespective of the presence of skin lesions.
Implications:
- Highlights the importance of considering meningococcemia in the differential diagnosis of acute polyarthritis, even in atypical presentations.
- Emphasizes the need for blood cultures in patients with unexplained fever and polyarthritis.
- Underscores the effectiveness of prompt antibiotic treatment for meningococcemia-associated arthritis.