A case of invasive meningococcal disease presenting as myopericarditis
File(s)
Published version
Author(s)
Durkin, Simon
Britton, Clemency
Cooke, Graham
Mehta, Ravi
Type
Journal Article
Abstract
Background
Neisseria meningitidis is a universally-feared Gram negative diplococcus, and infection confers high rates of morbidity and mortality despite effective antimicrobial therapy. Invasive meningococcal disease most commonly presents with meningococcaemia or meningococcal meningitis.
Case report
72-year-old female, previously fit and well, was admitted with chest pain, and associated breathlessness and diarrhoea. The clinical picture was of a myopericarditis.
Results
Initial electrocardiogram (ECG) changes and elevated troponin were consistent with myopericarditis. Neisseria meningitidis W135 was cultured from blood, and subsequently from cerebrospinal fluid (CSF). Leptomeningeal meningitis and ventriculitis was evident on magnetic resonance imaging (MRI) of the brain. Treatment was commenced with intravenous ceftriaxone. The clinical course was complicated by pneumonia, influenza A infection, and fatal pulmonary embolism.
Conclusions
This case demonstrates the range of clinical features of invasive meningococcal disease, highlighting in particular that meningococcal bacteraemia can present clinically as myopericarditis, which may be present in a substantial proportion of cases. Prompt antimicrobial therapy, as well as an awareness of potential complications, are paramount in the clinical management of meningococcal myopericarditis.
Neisseria meningitidis is a universally-feared Gram negative diplococcus, and infection confers high rates of morbidity and mortality despite effective antimicrobial therapy. Invasive meningococcal disease most commonly presents with meningococcaemia or meningococcal meningitis.
Case report
72-year-old female, previously fit and well, was admitted with chest pain, and associated breathlessness and diarrhoea. The clinical picture was of a myopericarditis.
Results
Initial electrocardiogram (ECG) changes and elevated troponin were consistent with myopericarditis. Neisseria meningitidis W135 was cultured from blood, and subsequently from cerebrospinal fluid (CSF). Leptomeningeal meningitis and ventriculitis was evident on magnetic resonance imaging (MRI) of the brain. Treatment was commenced with intravenous ceftriaxone. The clinical course was complicated by pneumonia, influenza A infection, and fatal pulmonary embolism.
Conclusions
This case demonstrates the range of clinical features of invasive meningococcal disease, highlighting in particular that meningococcal bacteraemia can present clinically as myopericarditis, which may be present in a substantial proportion of cases. Prompt antimicrobial therapy, as well as an awareness of potential complications, are paramount in the clinical management of meningococcal myopericarditis.
Date Issued
2021-11
Date Acceptance
2021-07-01
Citation
Clinical Infection in Practice, 2021, 12
ISSN
2590-1702
Publisher
Elsevier
Journal / Book Title
Clinical Infection in Practice
Volume
12
Copyright Statement
© 2021 Published by Elsevier Ltd on behalf of British Infection Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Publication Status
Published
Article Number
100082
Date Publish Online
2021-07-09