Although chronic meningococcemia is an uncommon disorder, it is of great importance to clinicians across multiple disciplines because it presents similarly to reactive, neoplastic, or rheumatic disorders. Ruling out chronic meningococcemia, however, represents a diagnostic challenge because routine microbiological investigations frequently fail to identify Neisseria meningitidis. Although treatment with corticosteroids might be helpful in various conditions, corticosteroid treatment may lead to severe complications in underlying chronic meningococcemia.
We describe a patient with a history of recurrent fever, arthralgia, and disseminated skin lesions. The patient was assumed to have Sweet syndrome and was treated with corticosteroids. Subsequently the patient developed meningococcal meningitis and was admitted to the neurointensive care unit. Chronic meningococcemia was confirmed retrospectively by nonroutine polymerase chain reaction and silver staining of skin biopsy specimens. Immunologic workup revealed decreased IgG subclass 3.
Conclusions and Relevance
Consideration of chronic meningococcemia is important when a patient presents with a history of fever and disseminated skin lesions. Polymerase chain reaction testing of skin biopsy specimens should be performed more systematically if the results of routine microbiological investigations remain unrevealing. In addition, silver staining of skin lesions can help establish the diagnosis. Eventually, testing for immune deficiencies should more routinely follow a confirmed diagnosis of chronic meningococcemia.
Livid-erythematous maculopapular skin lesions on the patient’s right hand (A) and thigh (B) at initial admission. Lesions were localized mainly on the trunk, arms, and legs.
Dermal ectatic lymph vessels (A) and capillaries (B) with perivascular lymphohistiocytic infiltration with numerous lymphocytes and a large number of neutrophil granulocytes (original magnification x40).
Silver staining of the same specimen revealing neisserial diplococci (arrowhead) (scale bar indicates 10 μm).
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