Myopericarditis and atrial fibrillation complicating meningococcal meningitis in a human immunodeficiency virus-infected man who has sex with men: a case report

Ziqiang Zhu,Ali Shahzad,Alexander Rozin

doi:10.1099/jmmcr.0.000062

Abstract

Introduction: Neisseria meningitidis is the leading cause of bacterial meningitis in children and young adults. Multiple complications have been reported previously, either at the time of presentation or later during the recovery phase of the illness. Cardiac arrhythmias and electrocardiogram (ECG) abnormalities have rarely been reported in N. meningitidis infection. Case presentation: We report a 48-year-old African-American man, with newly diagnosed human immunodeficiency virus infection, admitted with a diagnosis of meningococcal meningitis. An initial 12-lead ECG at admission showed a normal sinus rhythm with widespread concave ST elevation. The patient's troponin level was significantly elevated. A Transthoracic echocardiogram revealed left ventricle moderate anterior pericardial effusion. He was treated with antibiotics for meningitis and ibuprofen for myopericarditis. He subsequently developed atrial fibrillation, which was suppressed with metoprolol, diltiazem and amiodarone during hospitalization. To the best of our knowledge, this is the first reported case of atrial fibrillation complicating meningococcal meningitis. Conclusion: Myopericarditis complicates the course of meningococcal meningitis. Various forms of cardiac arrhythmias can occur during the course of meningococcal infection. Therefore, telemetry and serial ECG monitoring are recommended throughout the course of meningococcal infection.

Highlights

Neisseria meningitidis is the leading cause of bacterial meningitis in children and young adults
We report a case of meningococcal meningitis without bacteraemia in a human immunodeficiency virus (HIV)-infected man who has sex with men, who developed myopericarditis and atrial fibrillation
The 12-lead ECG at admission showed a normal sinus rhythm with widespread concave ST elevations (Fig. 1), which led to the concern of pericarditis

Summary

Introduction

Neisseria meningitidis is the leading cause of bacterial meningitis in children and young adults (Durand et al, 1993; Edmond et al, 2010; Abio et al, 2013). We report a case of meningococcal meningitis without bacteraemia in a human immunodeficiency virus (HIV)-infected man who has sex with men, who developed myopericarditis and atrial fibrillation. Initial vital signs included a temperature of 36.8 uC, blood pressure of 103/70 mmHg and a pulse of 103 beats min21 He developed a fever of 39.1 uC later the same day. The 12-lead ECG at admission showed a normal sinus rhythm with widespread concave ST elevations (Fig. 1), which led to the concern of pericarditis. From the day 3 of his hospital stay, neurologically intact, haemodynamically stable and with all serum electrolytes normal, he developed atrial fibrillation with a rapid ventricular response (heart rate 139–165 beats min21) (Fig. 2). Subsequent telemetry monitoring and serial ECG analysis from day 8 showed a normal sinus rhythm and no further atrial fibrillation.

Conclusion

Discussion