title: Painful knees and hearing-loss: a rare presentation of meningococcal disease.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, Zuid-Holland, The Netherlands.
authors.forename: Vivienne
authors.initials: V
authors.lastname: Kahlmann
authors.affiliation: Department of Rheumatology, Franciscus Gasthuis & Vlietland, Rotterdam, Zuid-Holland, The Netherlands.
authors.forename: Celina
authors.initials: C
authors.lastname: Alves
authors.affiliation: Department of Medical Microbiology, Franciscus Gasthuis & Vlietland, Rotterdam, Zuid-Holland, The Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Koeleman
authors.affiliation: Department of Rheumatology, Franciscus Gasthuis & Vlietland, Rotterdam, Zuid-Holland, The Netherlands.
authors.forename: Lindy-Anne
authors.initials: LA
authors.lastname: Korswagen
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000382:microbiology*; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000382:microbiology; D042241:Early Diagnosis; D005260:Female; D034381:Hearing Loss / Q000382:microbiology*; D006801:Humans; D007719:Knee Joint / Q000382:microbiology*; D008589:Meningococcal Infections / Q000175:diagnosis*; D009345:Neisseria meningitidis