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2018 ; 11
(ä): 87-90
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Invasive meningococcal disease without meningitis: a forgotten diagnosis
#MMPMID29695936
Walayat S
; Hussain N
; Malik AH
; Vazquez-Melendez E
; Aulakh BS
; Lynch T
Int Med Case Rep J
2018[]; 11
(ä): 87-90
PMID29695936
show ga
Neisseria meningitidis, a Gram-negative diplococcus, is an uncommon cause of
pneumonia. There have been only about 344 cases reported worldwide from 1906 to
2015. To our knowledge, there have been only 3 cases reported in the USA in the
past 2 decades. We present a case of a 72-year-old male with a past medical
history of severe COPD, obstructive sleep apnea, and stage I lung cancer status
post-stereotactic body radiation therapy 1 year ago, who was admitted with a
6-day history of productive cough with yellowish sputum, shortness of breath,
extreme myalgias, and fatigue. Chest X-ray revealed an infiltrative process in
the left lower lung field and left-sided pleural effusion. Blood cultures grew
beta-lactamase-negative N. meningitidis after 24 hours. Our patient was initially
treated with broad-spectrum antibiotics, which were later switched to amoxicillin
to complete a total of 14 days of antibiotics. Diagnosing meningococcal pneumonia
requires a high level of suspicion, as sputum cultures may be falsely positive
due to asymptomatic carriage of the organism in the upper respiratory tract in up
to 10% of outpatient population. We highlight this case as early recognition and
treatment is critical. The case fatality rate for N. meningitidis pneumonia has
been reported to be higher compared with meningococcal meningitis.