Bloodstream Infection by Neisseria meningitidis

A 33-year-old, previously healthy female patient presented with a 3-week history of skin rash and fever (up to 40 ° C) as well as arthritic symptoms in the left upper ankle. On physical examination, monomorphic, bright red subcutaneous nodules measuring up to approximately 1 × 1 cm without ulceration were striking; these were disseminated over the entire integument, in particular the extremities, excluding the head and mucous membranes (Figure). Laboratory results revealed leukocytosis (14/nL) and elevated creatinine levels (88 mg/L, normal value <5 mg/L). Four serial blood cultures detected the growth of Neisseria meningitidis serogroup C. We initiated antibiotic treatment with high-dose penicillin G. The further diagnostic work-up to identify an immune defect yielded no abnormalities. Antibiotic treatment achieved a complete resolution. Blood cultures represent a central diagnostic tool in disorders involving fever of unknown origin; bacteremia due to Neisseria meningitidis, a rare differential diagnosis, should be taken into consideration in the case of cyclic fever with maculopapular rash.

Figure

Dr. med. Jonas Jaromier Staudacher, Berlin Institute of Health at Charité – Universitätsmedizin Berlin Charité;
Universitätsmedizin Berlin, Campus Benjamin Franklin, [e-mail]

Dr. Marcel Wittenberg, Prof. Dr. Dr. Thomas Schneider, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Wittenberg M, Schneider T, Staudacher JJ: Bloodstream infection by Neisseria meningitidis. Dtsch Arztebl Int 2022; 119: 557. DOI: 10.3238/arztebl.m2022.0156