A man in his 80s presented to the hospital with a 36-hour history of fever, myalgia, bilateral shoulder and right knee pain. Joint fluid aspirates from his shoulders and right knee isolated Gram-negative diplococci. After failing to grow on standard and selective media, Neisseria meningitidis was identified by 16s PCR and subsequently typed as serogroup C. He had no clinical features of meningitis or meningococcaemia. Blood cultures were negative and an EDTA blood sample was negative for meningococcal ctrA gene. Urine PCR was negative for Neisseria gonorrhoeae. He was treated successfully with two arthroscopic joint washouts of his right knee, aspirates of both shoulders, 40 days of intravenous ceftriaxone and intensive physiotherapy as both an inpatient and outpatient. In the literature, we have not found any previously documented cases of serogroup C meningococcus causing polyarticular primary septic arthritis in this age group or guidance on duration of antibiotic treatment. Literature on the impact of rehabilitation to baseline function was also found to be lacking. Although rare, primary meningococcal arthritis (PMA) should be considered as a differential diagnosis in cases of acute polyarticular septic arthritis. Polyarticular PMA in older adults may require prolonged rehabilitation before one might expect to return to premorbid function.
- bone and joint infections
- physiotherapy (rehabilitation)
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Contributors TWN: wrote the main body of paper, performed literature review. TTH: composed tables/figures, literature review, edited drafts, formatting and bibliography. EMT: wrote sections encompassing microbiological approach and diagnosis, edited drafts and reviewed final submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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