title: Acute polyarthritis in a young patient caused by meningococcal and parvovirus B19 infections: a case report and review of the literature.
abstract: BACKGROUND
  Meningococcal infection is a multifaceted disease including acute polyarthritis. This presentation should be known by clinicians in order to prevent delay in treatment. We report what we believe to be the first case of an association of parvovirus B19 and meningococcal polyarthritis in a young adult.
  
  
  METHODS
  A 19-year-old Caucasian woman presented to our hospital with fever, intense leg pain, and a transient rash. A physical examination showed asymmetric polyarthritis and no neurological abnormalities. A parvovirus B19 polymerase chain reaction performed using a blood sample and knee fluid aspirate came back positive, but serology was negative for immunoglobulin M and positive for immunoglobulin G. A blood culture was positive for serotype C meningococcus; a polymerase chain reaction performed for Neisseria meningitidis was positive in joint fluid but negative in blood samples (performed after antibiotic treatment had begun). Our patient was treated with ceftriaxone for 15 days, associated with analgesic therapy. Hydroxychloroquine treatment was introduced 5 months after the onset of polyarthritis because of persisting inflammatory arthralgia.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first case report of polyarthritis caused by concomitant meningococcal and parvovirus B19 infections. This unusual presentation of meningococcal disease may have resulted from the persistent parvovirus B19 infection. Our experience with this case illustrates the need for a systematic approach to the diagnosis of febrile acute polyarthritis. Only long-term follow-up will reveal if this infectious polyarthritis will evolve towards an autoimmune rheumatism.
authors.affiliation: Service de Maladies Infectieuses Aigues, Pôle Maladies Infectieuses, Assistance Publique Hôpitaux de Marseille, CHU Timone, Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lavoipierre
authors.affiliation: Service de Rhumatologie, Assistance Publique Hôpitaux de Marseille, CHU Sainte Marguerite, 13009, Marseille, France.
authors.forename: Anna
authors.initials: A
authors.lastname: Dellyes
authors.affiliation: Service de Maladies Infectieuses Aigues, Pôle Maladies Infectieuses, Assistance Publique Hôpitaux de Marseille, CHU Timone, Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Aubry
authors.affiliation: Pôle Maladies Infectieuses, Fédération de Microbiologie, Assistance Publique Hôpitaux de Marseille, CHU Timone, Institut Hospitalo-Universitaire Méditerranée Infection, 13015, Marseille, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Zandotti
authors.affiliation: Service de Rhumatologie, Assistance Publique Hôpitaux de Marseille, CHU Sainte Marguerite, 13009, Marseille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lafforgue
authors.affiliation: Service de Maladies Infectieuses Aigues, Pôle Maladies Infectieuses, Assistance Publique Hôpitaux de Marseille, CHU Timone, Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France.|Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Institut Hospitalo-Universitaire Méditerranée-Infection, Marseille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Parola
authors.affiliation: Service de Maladies Infectieuses Aigues, Pôle Maladies Infectieuses, Assistance Publique Hôpitaux de Marseille, CHU Timone, Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France. jean-christophe.lagier@ap-hm.fr.|Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Institut Hospitalo-Universitaire Méditerranée-Infection, Marseille, France. jean-christophe.lagier@ap-hm.fr.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lagier
mesh_terms: D000698:Analgesia / Q000379:methods; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000914:Antibodies, Viral; D001168:Arthritis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D002443:Ceftriaxone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008589:Meningococcal Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D010146:Pain; D010147:Pain Measurement; D010322:Parvoviridae Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D016732:Parvovirus B19, Human / Q000302:isolation & purification; D010689:Phlebitis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D016133:Polymerase Chain Reaction; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000914:Antibodies, Viral; D002443:Ceftriaxone
keywords: Case report; Meningococcemia; Parvovirus B19; Polyarthritis