Chronic meningococcemia: a rare presentation of meningococcal disease: case report

Abstract

Chronic meningococcemia is a rare clinical presentation within the spectrum
of infections due to Neisseria meningitidis, which was first described in 1902.
It is defined as a chronic and benign meningococcal bacteremia without
meningeal signs or symptoms with at least one week’s duration, characterized
by intermittent or continuous fever, polymorphic cutaneous rash, and migratory
arthropathy. The incidence is believed to be around 1:200,000 inhabitants. It
affects predominantly young people and adults, and it is equally distributed
between genders. Diagnosis may be challenging in the early stages of the
disease because of the difficulty in isolating Neisseria meningitidis (it reaches
74% of positivity in advanced stages). Recently, the use of PCR for detecting
Neisseria sp antigen in skin biopsies specimens has been considered for those
culture-negative cases. The authors report a case of a 54-year-old female
patient who sought medical attention for a five-day fever followed by arthralgia
and skin lesions predominantly in the lower limbs. The patient progressed to
a toxemic clinical status that improved after the administration of antibiotic
therapy, which consisted of oxacillin and ceftriaxone. The diagnosis of chronic
meningococcemia was performed after the isolation of Neisseria meningitidis
in two different blood sample cultures. This is, to our knowledge, the first
case of chronic meningococcemia described in Brazil (up to the writing of this
report).