Abstract Background Neisseria meningitidis typically presents with meningeal signs and symptoms. We report a rare case of N. meningitidis bacteremia without meningitis in a patient with chronic alcohol dependence who presented with community-acquired pneumonia. Case Presentation A 51-year-old man with a history of chronic alcohol dependence and prior alcohol withdrawal seizure presented with a 3-day history of productive cough and right-sided pleuritic chest pain. He denied headache, neck stiffness, or photophobia. On examination, he was afebrile, tachycardic, and had a normal oxygen saturation on room air. Pulmonary auscultation revealed crackles and dullness on percussion in the right lower lung field without neck stiffness, rash, or altered mentation. Laboratory studies showed a white blood cell count of 7 ×109/L, a negative viral panel, and elevated D-dimer (11.7 µg/mL). Chest CT angiogram of the chest was negative for pulmonary embolism, however, demonstrated right lower lobe consolidation consistent with pneumonia. Blood cultures were obtained and patient was started on broad spectrum antibiotics. The following day, blood culture flagged positive and the multiplex PCR panel as well as culture growth later detected Neisseria meningitidis. The patient was placed on droplet precautions, and antibiotics were switched to ceftriaxone 2gm daily. As he remained hemodynamically stable without meningeal signs, lumbar puncture was deferred. His condition improved clinically, repeat blood cultures were negative, and he completed the antibiotic course and was successfully discharged to home. Discussion Neisseria meningitidis is a gram-negative diplococcus primarily known for causing meningitis and meningococcemia, though it can rarely present as primary meningococcal pneumonia. The organism colonizes the upper respiratory tract, can lead to infection, especially in individuals with chronic alcohol use, smoking, or immunocompromised. These cases are uncommon but clinically significant, accounting for a small proportion of invasive meningococcal disease. The presentation of meningococcal pneumonia is often indistinguishable from other community-acquired pneumonias, making laboratory confirmation essential. Classic meningeal symptoms are typically absent, as seen in our patient. Rapid molecular techniques such as multiplex PCR play a crucial role in early diagnosis and targeted management. Ceftriaxone remains the treatment of choice and lumbar puncture is reserved for patients with neurological symptoms. This case highlights the importance of maintaining a broad differential when evaluating pneumonia in high-risk individuals and reinforces the need for clinician awareness of this atypical presentation to ensure timely diagnosis and optimal outcomes. This abstract is funded by: None
Hassan et al. (Fri,) studied this question.