Primary Meningococcal Septic Arthritis Case Report and Literature Review of an Unusual Manifestation of Meningococcal Disease

• Published in: Bulletin of the Hospital for Joint Diseases (2013) 2019-06, Vol.77 (2), p.140-145
• Main Authors: Gómez, Borja Occhi, Feito, César Ramírez, Vázquez, Diego García-Germán, Vega, Marta García, García Viejo, Miguel Ángel
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Adolescent; Anti-Bacterial Agents - administration & dosage; Arthritis, Infectious - diagnosis; Arthritis, Infectious - microbiology; Arthritis, Infectious - physiopathology; Arthritis, Infectious - therapy; Arthroscopy - methods; Ceftriaxone - administration & dosage; Humans; Knee Joint - diagnostic imaging; Knee Joint - microbiology; Male; Meningococcal Infections - diagnosis; Meningococcal Infections - physiopathology; Meningococcal Infections - therapy; Neisseria meningitidis - isolation & purification; Recovery of Function; Return to Sport; Synovial Fluid - microbiology; Therapeutic Irrigation - methods; Treatment Outcome
• ISSN: 2328-5273

Primary meningococcal septic arthritis (PMSA) is an unusual manifestation of meningococcal disease. It is defined as the presence of acute septic arthritis without association with meningitis or the classic meningococcemia and isolation of Neisseria meningitidis in synovial fluid and blood culture. Diagnosis and early treatment, combining antibiotic and joint drainage, are fundamental. We present the case of a healthy 17-year-old male who presented with history of an acute onset, painful knee accompanied by fever. N. meningitidis was cultured from the synovial fluid. He was treated with arthroscopic lavage and intravenous ceftriaxone for 2 weeks. He was discharged 7 days after admission receiving outpatient intravenous ceftriaxione for 6 days and was ultimately transitioned to oral ciprofloxacin for 2 weeks thereafter. At the final follow-up visit, he had returned to sports activity with a normal knee joint. We have done an exhaustive literature review in PubMed. Forty-four articles were included, with a total of 46 patients, to which we added ours. We collected the available demographic data, analytical values, culture tests, treatment, and evolution. This case illustrates an unusual presentation of N. meningitidis infection. Diagnostic suspicion is essential. Joint washing and antibiotics are the mainstays of treatment. Early and proper treatment prevents complications and mortality. Our main objective was to evaluate the diagnostics tools and treatment in PMSA. As a secondary objective, we evaluated the cases with negative cultures in order to evaluate the criteria for the diagnostic suspicion of PMSA.