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Laurent Parmentier, MD, PhD; Christian Garzoni, MD; Christophe Antille, MD; Laurent Kaiser, MD; Béatrice Ninet, PhD; Luca Borradori, MD

Arch Dermatol. 2008;144(6):770-773.

Background  Chronic meningococcemia (CM) is a diagnostic challenge. Skin lesions are frequent but in most cases nonspecific. Polymerase chain reaction (PCR)–based diagnosis has been validated in blood and cerebrospinal fluid for acute Neisseria meningitidis infection, in patients in whom routine microbiologic tests have failed to isolate the bacteria. In 2 patients with CM, we established the diagnosis by a newly developed PCR-based approach performed on skin biopsy specimens.

Observations  Two patients presented with fever together with systemic and cutaneous manifestations suggestive of CM. Although findings from blood cultures remained negative, we were able to identify N meningitidis in the skin lesions by a newly developed PCR assay. In 1 patient, an N meningitidis strain of the same serogroup was also isolated from a throat swab specimen. Both patients rapidly improved after appropriate antibiotherapy.

Conclusions  To our knowledge, we report the first cases of CM diagnosed by PCR testing on skin biopsy specimens. It is noteworthy that, although N meningitidis–specific PCR is highly sensitive in blood and cerebrospinal fluid in acute infections, our observations underscore the usefulness of PCR performed on skin lesions for the diagnosis of chronic N meningitidis infections. Whenever possible, this approach should be systematically employed in patients for whom N meningitidis infection cannot be confirmed by routine microbiologic investigations.

Author Affiliations: Polyclinique de Dermatologie et Vénéréologie (Drs Parmentier, Antille, and Borradori), Service de Maladies Infectieuses (Drs Garzoni and Kaiser), and Laboratoire Central de Bactériologie (Dr Ninet), Hôpital Universitaire de Genève, Genève, Switzerland.