Rapid recovery following fulminant meningococcemia complicated by myocarditis in a 15-year-old Nepalese girl: a case report
Pratyush Shrestha,1 Nabin K Shrestha,2 Smith Giri3
1Department of Surgery, College of Medical Sciences, Bharatpur, Nepal; 2Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal; 3Department of Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
Introduction: Fulminant meningococcemia is a relatively rare life-threatening disease caused by Neisseria meningitidis. The clinical presentation is varied, but, when associated with myocarditis, it carries a particularly poor prognosis. We report a case of a patient with fulminant meningococcemia who subsequently developed severe myocardial dysfunction and successfully recovered within a period of 14 days of hospitalization.
Case presentation: A 15-year-old girl presented with headache, fever, body ache, and diarrhea for 1 day, and ecchymotic rash over her body for 4 hours. Blood cultures confirmed infection with N. meningitidis. After 6 days in the hospital, the patient developed anasarca, elevated jugular venous pressure, and shock. The patient was managed with intravenous ceftriaxone and captopril. Over the next 3 days the patient rapidly improved and started walking.
Conclusion: Meningococcemia complicated by myocarditis has an extremely poor prognosis with high mortality. Our case suggests that recovery from a severe myocardial dysfunction can occur rapidly within a few days. Prompt recognition and management in this case might have contributed to the patient's rapid recovery from myocarditis.
Keywords: Neisseria meningitidis, Nepal, recovery, shock
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