Disseminated meningococcal infection presenting with constrictive pericarditis and bilateral septic arthritis without meningitis: A case report.

Abstract

Invasive meningococcal disease is a life-threatening infection that classically presents as meningitis or meningococcemia. Extra-meningeal manifestations, including pericarditis and septic arthritis, are uncommon and may complicate diagnosis, particularly in the absence of meningeal involvement. A previously healthy vaccinated man in his 50s presented with acute bilateral knee pain and swelling following a short history of fever, productive cough, fatigue, and dyspnea. Blood cultures grew Neisseria meningitidis serogroup W, whereas cerebrospinal fluid, synovial fluid, and pericardial fluid cultures remained negative. Cardiac magnetic resonance imaging demonstrated constrictive pericarditis with circumferential pericardial enhancement and pericardial effusion. The patient was successfully treated with intravenous ceftriaxone, colchicine, ibuprofen, pericardiocentesis, and bilateral knee washout, followed by oral ciprofloxacin. This case adds to the limited literature describing concurrent cardiac and musculoskeletal manifestations of invasive meningococcal disease without meningitis and shows the importance of early recognition, comprehensive investigation and multidisciplinary management of these uncommon presentations.