Primary meningococcal arthritis and endogenous endophthalmitis: a case report.

INTRODUCTION Arthritis and endophthalmitis are both recognised complications of meningococcal infection. They may occur in the presence or absence of meningitis or meningococcaemia. Primary meningococcal arthritis (PMA) and endophthalmitis are important diagnoses to recognise as delayed treatment would result in permanent joint and eye damage. We report the first patient with both PMA and meningococcal endophthalmitis and present a review of the literature. CLINICAL PICTURE An afebrile, non-toxic, 54-year-old female presented with arthritis and a painful red left eye following an episode of diarrhoea. An initial diagnosis of reactive arthritis with uveitis was made. However, subsequent microbiological investigations isolated Neisseria meningitides thus confirming the final diagnosis. TREATMENT Antibiotics were instituted. OUTCOME There was complete resolution of the arthritis but her left eye vision had deteriorated to just perception of light. CONCLUSION The presentations of PMA and meningococcal endophthalmitis are often confusing. This should be considered in the differential diagnosis of reactive arthritis and acute dermatitis-arthritis syndrome.