A Case of Meningococcal Pericarditis: Uncommon Complication of Purpura Fulminans

Purpura fulminans (PF) is a severe infection caused by Neisseria meningitidis that necessitates prompt recognition and intensive care. The researchers discussed an atypical complication following an initially positive recovery from PF.

A previously healthy 5-month-old girl arrived at the emergency department exhibiting fever, septic shock, and skin necrosis. She was treated in the Pediatric Intensive Care Unit with fluid resuscitation, norepinephrine, antibiotics, corticosteroids, and mechanical ventilation, showing improvement within 48 hours. She was successfully weaned off vasoactive medications and extubated, with initial blood tests confirming N. meningitidis infection through polymerase chain reaction (PCR).

However, on the fourth day of treatment, the patient developed a fever and her C-reactive protein (CRP) level increased to 150 mg/L. Despite normal results from clinical examinations, a cerebral scan, and echocardiography, persistent fever led to a repeat echocardiogram on day seven, revealing a 17 mm pericardial effusion, indicating pre-tamponade. The patient underwent pericardiocentesis, which revealed exudative fluid rich in neutrophils and positive for N. meningitidis via PCR. She continued on antibiotics, and after 48 hours, her fever subsided. The pericardial drain was removed after 72 hours, and she was discharged after 17 days.

Complement deficiency was ruled out with a normal serum complement profile. This case exemplifies disseminated meningococcal disease with pericarditis (DMP) as classified by Finkelstein et al. in 1997. Despite sterile cultures of the pericardial fluid, purulent pericarditis was diagnosed based on the rapid onset of symptoms and the fluid's cellularity combined with positive PCR results. This case highlights the importance of considering purulent pericarditis in patients with ongoing fever during meningococcal infections.

Source: Miraoui A, Koumi Y, Daoud Y, et al. Pericardial Effusion in N. meningitidis Infection. Indian J Pediatr (2025). https://doi.org/10.1007/s12098-025-05500-2

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