Atypical clinical presentation of meningococcal meningitis: a case report.
A young woman was examined in the Emergency Department for fever, pharyngitis and widespread petechial rash. Physical examination, including neurological evaluation, did not show any other abnormalities. Chest X-ray was negative. Blood exams showed leukocytosis and CPR 20 mg/dL (nv<0.5 mg/dL). On the basis of these results and petechial rash evidence, lumbar puncture was performed. CSF was opalescent; physico-chemical examination showed: total proteins 2.8 (nv 0.15-0.45), glucose 5 (nv 59-80), WBC 7600/μL (nv 0-4/ μL). In the hypothesis of meningococcal meningitis, antimicrobial therapy was started. Blood and cerebrospinal fluid cultures were positive for N. meningitidis. During the first hours the patient experienced hallucinations and mild psychomotor agitation, making a spontaneous recovery. A brain MRI showed minimal extra-axial inflammatory exudates. She was discharged after 10 days in good condition. We underline the need to consider meningococcal meningitis diagnosis when any suggestive symptom or sign is present, even in the absence of the classic meningitis triad, to obtain earlier diagnosis and an improved prognosis.
Dipartimento di Malattie Infettive e Tropicali, ASST Spedali Civili, Brescia, Italy.
Ilaria
I
Izzo
Scuola di Specializzazione in Medicina Interna, Universitá di Brescia, Brescia, Italy.
Paola
P
Pileri
UO Neurologia, ASST Franciacorta, Chiari, Brescia, Italy.
Maria
M
Merello
Servizio di Anestesia e Rianimazione, ASST Franciacorta, Chiari, Brescia, Italy.
Paolo
P
Gnesin
Servizio di Anestesia e Rianimazione, ASST Franciacorta, Chiari, Brescia, Italy.
Enrico
E
Cogi
UO Medicina Generale, ASST Franciacorta, Chiari, Brescia, Italy.
Carlo
C
Aggiusti
UO Medicina Generale, ASST Franciacorta, Chiari, Brescia, Italy.
Laura
L
Giacomelli
UO Medicina Generale, ASST Franciacorta, Chiari, Brescia, Italy.
Stefano
S
Ettori
UO Medicina Generale, ASST Franciacorta, Chiari, Brescia, Italy.
Paolo
P
Colombini
Dipartimento di Emergenza e Accettazione, ASST Franciacorta, Chiari, Brescia, Italy.
Andrea
A
Collidá
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D038524:Diffusion Magnetic Resonance Imaging; D005334:Fever / Q000209:etiology*; D006212:Hallucinations / Q000209:etiology; D006801:Humans; D007121:Immunocompetence; D008585:Meningitis, Meningococcal / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D009345:Neisseria meningitidis / Q000302:isolation & purification*; D059906:Neuroimaging; D010612:Pharyngitis / Q000209:etiology*; D011595:Psychomotor Agitation / Q000209:etiology; D011693:Purpura / Q000209:etiology*; D013129:Spinal Puncture
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone