Meningococcal myocarditis is a rarely diagnosed infection and could be the consequence of primary invasive infection or late immunologic complications. An unusual presentation of meningococcemia in an immunocompetent adult is described, with Neisseria meningitidis identified as the cause of selective right-sided heart failure in a case of acute myocarditis.
CASE REPORTA 47-year-old man was admitted to the hospital with a complaint of chills, nausea, vomiting, and diarrhea for 24 h. The patient took no medications and denied tobacco, alcohol, or illicit drug use, and no cardiovascular risk factors were present. Vital signs on admission were as follows: temperature 38.5°C; heart rate, 120 beats/min; blood pressure, 78/45 mmHg; and respiratory rate, 30 breaths/min. Examination revealed the following: chest, bilaterally clear; cardiac activity, tachycardic and regular, no murmur, no peripheral edema, and flat neck veins; abdomen, nontender, with normal bowel sounds and without hepatosplenomegaly; neurologic status, normal state of consciousness and no sign of meningismus or sensorimotor impairment; extremities cold, without skin rash. Laboratory investigations revealed a level of C-reactive protein of 114 mg/liter and a white blood cell count of 27 ϫ 10 9 /liter. Cardiac biomarkers, kidney and liver function, coagulation study, and urinalysis were normal. Blood and stool cultures were also performed. The first 12-lead electrocardiogram (ECG) demonstrated isolated sinus tachycardia. Chest X-ray and abdominal ultrasound failed to show any pathology.The patient was initially treated with fluid resuscitation and intravenous cefotaxime (3 g/day) and ciprofloxacin (400 mg twice a day). Systemic hypotension initially resolved. Seven hours after admission, the patient developed acute onset of orthopnea and his exam was significant for distension of the jugular veins. The next ECG revealed acute concave upwards ST-segment elevation in posterior and lateral leads without any mirroring in the opposite leads. The cardiac troponin level was dramatically increased (55 ng/ml). Transthoracic 2-dimensional echocardiography showed a posterolateral dyskinesis, normal inferior kinetic and impaired right ventricular contractility, dilation of the inferior vena cava, and no pericardial effusion. Cardiovascular magnetic resonance imaging (MRI) was performed and demonstrated impairment of right ventricular function associated with nonischemic damage (Fig. 1A). The signs of heart failure and the ST-segment elevation resolved within 24 h without development of Q weave. On day two, Neisseria meningitidis was isolated from an initial blood culture (BacT/Alert blood culture system, identification by API NH biochemical kit; bioMérieux, Craponne, France), establishing the diagnosis of meningococcemia. The phenotypic determination, based on the antigenic formula (serogroup, serotype, and serosubtype), revealed a serogroup C isolate. The strain was susceptible to antibiotics of clinical interest (MICs were obtained for penicillin G, amoxicillin, an...
