Painful knees and hearing-loss: a rare presentation of meningococcal disease

A 49-year-old woman with a medical history of rheumatoid arthritis presented to the emergency room, with high fever and painful knees. In addition, she had had a mild headache for several days and some hearing loss over several months. We saw an ill patient with arthritis of both knees, from which p...

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Bibliographic Details
Published in:BMJ case reports 2016-06, Vol.2016, p.bcr2016214583
Main Authors: Kahlmann, Vivienne, Alves, Celina, Coleman, Johannes, Korswagen, Lindy-Anne
Format: Article
Language:English
Subjects:
Adult
Antibiotics
Arthralgia - microbiology
Arthritis, Infectious - diagnosis
Arthritis, Infectious - microbiology
Case reports
Diagnostic tests
Early Diagnosis
Europe (West)
Female
Fever
Hearing loss
Hearing Loss - microbiology
Hearing protection
Humans
Immunization
Infections
Knee
Knee Joint - microbiology
Meningitis
Meningococcal Infections - diagnosis
Morbidity
Mortality
Neisseria meningitidis
Patients
Penicillin
Pneumonia
Reminder of Important Clinical Lesson
Rheumatoid arthritis
Sepsis
White
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Summary:A 49-year-old woman with a medical history of rheumatoid arthritis presented to the emergency room, with high fever and painful knees. In addition, she had had a mild headache for several days and some hearing loss over several months. We saw an ill patient with arthritis of both knees, from which purulent fluid was aspirated. Antibiotics were started for septic arthritis of both knees and her condition improved rapidly. However, the headache persisted and the hearing loss worsened. At the time, meningitis was suspected. Initial knee aspiration culture was positive for Neisseria meningitidis. PCR of the cerebrospinal fluid sample also was positive for N. meningitidis. The patient was finally diagnosed with bilateral septic gonarthritis secondary to a bacterial meningitis caused by N. meningitidis.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2016-214583