Fulminant Neisseria septicemia with secondary hemophagocytic lymphohistiocytosis

Résumé fourni par la source

A 26-year-old male soldier stationed in hilly terrain presented with a febrile illness followed by migratory inflammatory arthritis and non-blanchable petechial lesions over the lower limbs. On admission to a tertiary center, he exhibited respiratory distress, a pansystolic murmur, and elevated acute-phase reactants. Initial investigations suggested sepsis with suspicion of infective endocarditis, but transthoracic echocardiography was unremarkable. Bone marrow examination revealed hemophagocytic lymphohistiocytosis (HLH), and bone marrow cultures identified Neisseria meningitidis, confirming fulminant meningococcal septicemia as the underlying cause. The patient was treated with intravenous immunoglobulin and broad-spectrum antibiotics, resulting in significant clinical improvement. This case highlights the rare presentation of N. meningitidis septicemia complicated by secondary HLH and the importance of early diagnosis and multidisciplinary management.

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