Meningococcal disease (MD), caused by Neisseria meningitidis, is a serious infection transmitted through respiratory droplets. The bacteria's capsule allows it to evade the immune system, leading to septicemia and meningitis. Symptoms typically appear within 1-14 days and can range from mild to severe, including fever, headache, neck stiffness, and purpura fulminans. Less common manifestations include pneumonia, conjunctivitis, AOM, epiglottitis, and others. Early diagnosis is challenging due to the similarity of initial symptoms to other bacterial infections. This case report details an unusual presentation of MD in an infant, illustrating the need for enhanced surveillance and awareness of atypical presentations.

Respiratory infections caused by N. meningitidis, including pneumonitis, have been reported. Primary meningococcal pneumonia occurs in 5-10% of MD cases and is clinically indistinguishable from pneumonia caused by other pathogens. The association between MD and AOM is less well-documented, with most cases being mild and not associated with systemic MD. Previous studies have highlighted the low prevalence of N. meningitidis in middle ear fluid cultures in patients with AOM, without accompanying systemic MD symptoms. This case report presents a unique situation where MD was associated with severe sepsis, meningitis, purulent AOM, and PS.

This is a case report of a previously healthy infant who presented to the emergency room with seizures and a high fever. A detailed history was obtained, including vaccination status (the infant had received all vaccines according to the Mexican National Immunization Program for her age, but not the meningococcal vaccine). Physical examination revealed purulent otorrhea from the right ear. Laboratory tests revealed marked leukocytosis, elevated procalcitonin, and CSF findings consistent with bacterial meningitis. A CT scan showed maxillary and ethmoidal sinusitis. Gram stain of the CSF revealed intracellular Gram-negative diplococci. Blood, CSF, and middle ear fluid cultures were positive for N. meningitidis serogroup B. The infant received intravenous vancomycin and ceftriaxone; vancomycin was discontinued once the N. meningitidis culture was confirmed. Both parents received rifampin prophylaxis. The patient recovered fully, and a three-month follow-up showed no sequelae.

The key finding is the unusual presentation of serogroup B MD in this infant, including the combination of meningitis, purulent AOM, and PS. This is the first confirmed case of this particular presentation reported by the authors. The infant's rapid response to treatment and lack of sequelae are also noteworthy. Laboratory findings were consistent with bacterial meningitis, showing marked leukocytosis with granulocytosis, elevated procalcitonin, and a CSF with high leukocyte count, elevated protein, and absent glucose. Gram stain confirmed the presence of intracellular Gram-negative diplococci, and cultures identified N. meningitidis serogroup B. The absence of meningococcal vaccination in the infant, given it is not included in the Mexican NIP, is a relevant factor. The presence of maxillary and ethmoidal sinusitis, noted on CT scan, suggests a potential route of infection.

This case highlights the variability of MD presentations and the challenges in early diagnosis. The atypical combination of symptoms could have delayed diagnosis or led to inappropriate initial treatment if active surveillance was not in place. The rapid recovery suggests that early intervention and appropriate antibiotic treatment can lead to favorable outcomes, even in severe cases. The lack of meningococcal vaccination in the Mexican NIP, as noted by the authors, makes surveillance even more crucial in endemic areas. This case underscores the need for increased awareness of atypical MD presentations and the importance of thorough investigation of febrile illnesses in infants. The rapid response to treatment might suggest that the upper respiratory tract infection contributed to a relatively good prognosis, although more research is needed to confirm this.

This case report describes a rare presentation of serogroup B meningococcal disease in a previously healthy infant. The unusual combination of meningitis, purulent AOM, and PS underscores the importance of active surveillance for early detection and appropriate management of MD, particularly in endemic regions. The patient's favorable outcome highlights the efficacy of prompt diagnosis and treatment. Future research could focus on the role of upper respiratory infections in MD prognosis and the impact of universal meningococcal vaccination on disease burden.

This study is limited by its nature as a single case report, meaning it may not be generalizable to the larger population. Furthermore, the absence of a follow-up CT scan prevents definitive assessment of the resolution of the paranasal sinusitis. The study's focus on a specific case limits inferences about the prevalence of this presentation or its association with other factors.