Painful knees and hearing-loss: a rare presentation of meningococcal disease

• Published in: BMJ case reports Vol. 2016; p. bcr2016214583
• Main Authors: Kahlmann, Vivienne, Alves, Celina, Coleman, Johannes, Korswagen, Lindy-Anne
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 29.06.2016; BMJ Publishing Group
• Series: Case Report
• Subjects: Adult; Antibiotics; Arthralgia - microbiology; Arthritis, Infectious - diagnosis; Arthritis, Infectious - microbiology; Case reports; Diagnostic tests; Early Diagnosis; Europe (West); Female; Fever; Hearing loss; Hearing Loss - microbiology; Hearing protection; Humans; Immunization; Infections; Knee; Knee Joint - microbiology; Meningitis; Meningococcal Infections - diagnosis; Morbidity; Mortality; Neisseria meningitidis; Patients; Penicillin; Pneumonia; Reminder of Important Clinical Lesson; Rheumatoid arthritis; Sepsis; White
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2016-214583

A 49-year-old woman with a medical history of rheumatoid arthritis presented to the emergency room, with high fever and painful knees. In addition, she had had a mild headache for several days and some hearing loss over several months. We saw an ill patient with arthritis of both knees, from which purulent fluid was aspirated. Antibiotics were started for septic arthritis of both knees and her condition improved rapidly. However, the headache persisted and the hearing loss worsened. At the time, meningitis was suspected. Initial knee aspiration culture was positive for Neisseria meningitidis. PCR of the cerebrospinal fluid sample also was positive for N. meningitidis. The patient was finally diagnosed with bilateral septic gonarthritis secondary to a bacterial meningitis caused by N. meningitidis.