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Meningococcal Pneumonia in a Young Healthy Male
Rare Case Studies

Meningococcal Pneumonia in a Young Healthy Male

Introduction

A 19-year-old male presented to the emergency department complaining of wheezing, pleuritic chest pain, fever (104 F), and coughing up blood.

History

The patient had no history of recent travel or contact with sick individuals. The patient had no significant medical background, and he was not taking any regular medication.

On admission, blood pressure was 130/60 mmHg, heart rate 94/min, and respiration was 20-22 breaths/minute.

Physical examination revealed rales and bronchial breathing in the right side of the lungs.

The preliminary clinical diagnosis was community acquired pneumonia.

Tests

  • WBC: 18.9 x 10(3)/μL (normal 3.40 – 11.80)
  • RBC: 4.4  x 10(6)/μL (normal 4.20 – 5.90)
  • HGB: 13.1 g/dL (normal 12.3 – 17.0)
  • HCT: 39.5% (normal 39.3 – 52.5)
  • Platelet count: 386 (normal 144 – 440)
  • C-RP: 22.1 <0.5
  • Sodium: 140 mmol/L  (normal 135–145)
  • potassium: 3.6 mmol/L (normal 3.5–4.5)
  • BUN: 15 mg/dL     (normal 6 – 20)
  • Creatinine: 1.45 mg/dL (normal .90 –1.30)
  • eGFR: 57 ml/min (normal >60)

Treatment/Outcome

The patient was started a combination of ceftriaxone (1 g IV q24h ) and levofloxacin 750 mg IV.

Culture results of the blood and sputum showed the patient was infected with N. meningitidis, and it was sensitive to both penicillin and ceftriaxone.

Ceftriaxone was continued in-patient for 4 days. Levofloxacin was discontinued after the blood culture results.

On day 4, the patient was discharged from the hospital and was seen by his primary physician 10 days later. He seemed to be completely cured. We recommended a return visit in 3 months.

Discussion

Meningococcal pneumonia is a very rare disease. Each year, approximately 1,000 people in the U.S. get meningococcal disease.

Meningococcal disease in general is rare, and it affects mostly infants and young adults. The most common manifestation of meningococcal disease is meningitis (about half in all infections) followed by septicemia (40% of cases). Meningococcal pneumonia occurs in between 5% and 15% of all patients with invasive meningococcal disease.

The bacterium Neisseria meningitidis, also called meningococcus, causes meningococcal meningitis. Establishing the diagnosis requires a high level of clinical awareness – the incidence is therefore very likely underreported and underestimated.

Early and appropriate antibiotic treatment markedly improves the outcome of meningococcal infections.

Penicillin is the drug of choice for the treatment of meningococcal meningitis and septicemia. Chemoprophylactic antimicrobials most commonly used to eradicate meningococci include rifampin, quinolones (eg, ciprofloxacin),  and ceftriaxone.

This patient had been started on ceftriaxone therapy, and was continued on it after the results of the culture were received.


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