[Subacute meningococcaemia during adalimumab therapy]

Abstract

Introduction: Subacute or chronic meningococcaemia is an invasive infection by Neisseria meningitidis characterized by fever lasting between a few days (subacute) and a week or more (chronic), cutaneous rash and arthralgia, without meningitis.

Patients and methods: A 59-year-old woman was admitted for a fever with cutaneous rash. She had a history of Crohn's disease diagnosed in 2016 and treated with adalimumab for 14 months at a dosage of 40mg/week. For 3 days, she presented fever with a temperature of up to 40°C associated with a non-itchy erythematous-papular eruption on all four limbs, especially the lower limbs. The lesions were mildly painful on palpation. The rest of the clinical examination was unremarkable. The patient did not have arthralgia or neurological symptoms, and in particular, she exhibited no meningeal syndrome. Blood cultures as well as PCR on a skin biopsy specimen confirmed the diagnosis of meningococcaemia. The patient was treated with ceftriaxone 2g/day for 4 days then amoxicillin 12g/day for 4 days. A favourable outcome was quickly achieved, and the condition subsided without sequelae.

Discussion: We report the first case of subacute meningococcaemia in a patient treated with anti-TNF alpha therapy. This case concerns the role of biotherapies, and more particularly anti-TNF alpha therapy, in the occurrence of particular infections but also in changes in their clinical presentation and clinical course, as in the present case without arthralgia.

Keywords: Adalimumab; Méningococcémie subaiguë; Neisseria meningitidis; Subacute meningococcaemia.