Fatal Acute Cellulitis Due to Neisseria meningitidis

Abstract

We describe the first fatal evolution of cellulitis due to Neisseria meningitidis serogroup Y involving an 85-year-old woman. She presented with an extensive cellulitis of the left side of the face, neck, and thorax and septic shock. In spite of active antibiotic therapy, evolution was rapidly fatal. CASE REPORTAn 85-year-old woman was admitted to the Intensive Care Unit of Saint-Germain-en-Laye Hospital with cellulitis of the face and neck and septic shock. She had been bedridden since 1998 following a traumatic vertebral compression (fourth lumbar vertebra) and right cerebral ischemia. She was undergoing corticosteroid therapy (0.5 mg of oral prednisone/kg of body weight/day for 2 years) for polymyalgia rheumatica. She had chronic heart and renal failure. Asthenia associated with pain on the left side of her neck began 8 days before admission. At the time of admission, her temperature was 38.3°C, her pulse rate was 120 (tachyarrhythmia), and her blood pressure was 80/50 mm Hg. She was conscious and alert. There were no symptoms of meningitis. The left side of the neck, the left shoulder, and the upper anterior part of the chest showed a painful erythema and edema and were swollen and warm. Clinical examination showed no angina and the recent partial loss of a left premolar. Otorhinolaryngologic evaluation showed a normal larynx, hypopharynx, and oropharynx and no phlegmon. A tumefaction of the submandibular space was observed; thus, submandibular sialadenitis was suspected. Laboratory findings included a white blood cell count of 2.71 ϫ 10 9 /liter with 46% neutrophils, a hemoglobin level of 7

Clinical characteristics and public health management of invasive meningococcal group W disease in the East Midlands region of England, United Kingdom, 2011 to 2013

“…In France, analysis of all cases of meningococcal disease between 1999 and 2002 found that MenW was significantly more likely than other capsular groups to be associated with meningococcal arthritis and meningococcal pneumonia [12]. Two patients in our cohort presented with cellulitis, which is a rare manifestation of IMD, previously only reported in individual case reports or small case studies and more often associated with MenY or MenB [15,16]. IMD presentation with common gastrointestinal symptoms such as diarrhoea and vomiting has also been reported in the literature.…”

Meningococcaemia causing necrotizing cellulitis associated with acquired complement deficiency after gastric bypass surgery: a case report

“…Numerous case reports identified Neisseria meningitidis as cause of severe cellulitis, more frequently involving the head and neck region [1][2][3][4][5].…”

A Case of Meningococcal Pyomyositis in an Otherwise Healthy Adult

“…The outcome was generally good, with only 1 attributed death. However, none of these cases were reported to have PM, although it is possible that some patients could have had unrecognized underlying muscle inflammation [ 17 ]. In fact, no cases of primary invasive meningococcal PM have been reported in the English language, even though proinflammatory cytokine-induced myositis (as evidenced by myalgia and elevated creatinine kinase) has been described [ 18 ].…”