Meningococcemia presenting as acute painful mononeuritis multiplex

doi:10.1016/j.clineuro.2011.10.031

Clinical Neurology and Neurosurgery

Volume 114, Issue 3, April 2012, Pages 284-286

https://doi.org/10.1016/j.clineuro.2011.10.031 Get rights and content

Introduction

Sepsis can cause acute damage or dysfunction of peripheral nerves [1] in the context of the so-called Systemic Inflammatory Response Syndrome (SIRS) [2]. Electrophysiological features are commonly consistent with axonal sensorimotor polyneuropathy. Various factors are thought to be involved in the pathogenesis of nerve dysfunction, including the release of inflammatory mediators, the production of free radicals and insufficient microcirculation [2]. Though common in the later stage of multi-organ failure, peripheral nerve symptoms are extremely rarely the initial manifestation of sepsis [1].

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Case report

A 26-year-old woman had acute onset of fever (>40 °C) partially responsive to paracetamol and mild headache. Three hours later she started complaining of pain and burning dysesthesia in the feet and she was admitted to hospital. Neurological examination revealed only mild weakness in flexor and extensor right toe muscles (4 MRC) and severe tactile dynamic allodynia in the feet, which prevented accurate sensory assessment. The patient was conscious and oriented and no meningeal signs were

Discussion

Meningococcal infection is a potentially life-threatening condition that classically presents with involvement of the central nervous system, of the adrenal glands and with sepsis [3]. Acute peripheral neuropathy as the presenting symptom of a N. meningitidis infection is an extremely rare event [4]. In our case the prompt recognition of this condition led to the rapid administration of adequate treatment, thus reducing the complications of sepsis, resulting ultimately in an excellent outcome.