Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Mod Rheumatol Case Rep. 2022 Jun 24;6(2):296-300. doi: 10.1093/mrcr/rxab049.
Primary meningococcal septic arthritis (PMSA) is an extremely rare local infection by Neisseria meningitidis in the absence of meningitis or meningococcaemia syndrome. A 30-year-old healthy, immunocompetent man presented with arthralgia, fever, chest rash, and significant swelling of the right knee. On admission, a disseminated maculopapular and purpuric rash, oligoarthritis, neutrophilia, and elevated acute phase reactants were documented. Following arthrocentesis of the right knee, isolation of N. meningitidis and the presence of calcium oxalate crystals in the synovial fluid were reported. The diagnosis of PMSA was made. Histological analysis of the skin lesion showed leucocytoclastic vasculitis. He was treated with intravenous ceftriaxone plus open surgical drainage and ambulatory cefixime with adequate response. After 1 month, he presented resolution of the pathological process. We performed an extensive review of the literature, finding that the key elements supporting the diagnosis of PMSA are prodromal upper respiratory tract symptoms and skin involvement prior to or synchronous with the arthritis. Also, the most frequently involved joint is the knee. This report is the first case of a patient presenting with PMSA associated with calcium oxalate crystals in the synovial fluid. Herein, we discuss the most frequent clinical manifestations, the unusual histological features, the recommended treatment, and the reported prognosis of this rare entity.
原发性脑膜炎球菌性化脓性关节炎（PMSA）是一种极为罕见的脑膜炎奈瑟菌局部感染，无脑膜炎或脑膜炎球菌血症综合征。一名 30 岁健康、免疫功能正常的男性出现关节痛、发热、胸部皮疹和右膝明显肿胀。入院时，出现弥漫性斑丘疹和紫癜性皮疹、寡关节炎、中性粒细胞增多和急性期反应物升高。右膝关节穿刺后，报告分离出脑膜炎奈瑟菌和关节滑液中存在草酸钙晶体。诊断为 PMSA。皮肤病变的组织学分析显示白细胞碎裂性血管炎。他接受了静脉注射头孢曲松联合开放性手术引流和门诊口服头孢克肟治疗，并获得了充分的反应。1 个月后，他的病情得到了缓解。我们进行了广泛的文献回顾，发现支持 PMSA 诊断的关键因素是关节炎前或同时出现上呼吸道症状和皮肤受累。此外，最常受累的关节是膝关节。本报告是首例患者出现与关节滑液中草酸钙晶体相关的 PMSA。在此，我们讨论了这种罕见疾病最常见的临床表现、不常见的组织学特征、推荐的治疗方法和报告的预后。
