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Splenic complications of invasive meningococcal disease (IMD) are well recognised, though cyst formation is rare, particularly in paediatric populations. The best approach to their management is not yet established. This case outlines the management of a splenic cyst in a 21-month-old boy following severe IMD. The case took place in the context of an acute emergence of serogroup W prompting significant media attention and subsequent change in vaccination practice at a jurisdictional level in Australia. The patient was critically unwell early in the illness, then later a collection in the left upper quadrant was detected, shown on ultrasound to be a 11.6×7.7 cm splenic cyst. In this case, the cyst was managed by ultrasound-guided drainage tube insertion. The residual collection was small and stable on subsequent imaging.

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We report on a 20-year-old female high-school student with fulminant meningococcal sepsis presenting as severe skin necrosis in lower extremities. The wound surface affected 2% of her total body surface area and was covered with black eschar. The adipose tissue beneath the eschar was degenerated and turned to necrosis as to deep fascia and periosteum of lower tibia. Excision of necrotic eschar, then covered with flaps on both legs resulted in a successful outcome.

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Although pericarditis may complicate the course of meningococcemia, it is distinctly unusual as a presenting sign. Herein we report a case of a previously healthy 16-year-old male with isolated meningococcal pericarditis, in which transthoracic echocardiography was of great importance for the initial diagnosis and for guiding the therapeutic approach during the hospitalization period. The patient presented with symptoms of chest pain and fever that deteriorated into cardiac tamponade. Pericardiocentesis was successful and Neisseria meningitidis was identified as the causative agent in the pericardial fluid. Because of failure of clinical resolution, echocardiogram was repeated and showed evidence of maintenance of large echo dense content in pericardial space. The presence of purulent content was confirmed during open-chest surgery. The role of echocardiography for the correct management of this rare form of pericarditis is discussed.

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The authors report a rare case of acute hematogenous osteomyelitis in a premature very low-birth weight infant caused by Neisseria meningitidis, a microorganism which occasionally causes arthritis, but is very rarely involved in bone infections. The strong teamwork of clinicians, the clinical microbiologist and the radiologist allowed the prompt formulation and confirmation of the clinical suspect (regardless of the paucity of symptoms and systemic signs), the rapid isolation of the microorganism and the prompt initiation of a specific therapy, thus obviating the need for a more invasive bone biopsy, which would have been hazardous considering the risks associated with an invasive procedure, and much higher in our case because of the young age of the patient and his prematurity. Moreover, this case confirms that early ultrasonographic examination may anticipate the diagnosis and the initiation of therapy in case of a clinical suspicion of acute hematogenous osteomyelitis, thus avoiding serious complications such as growth disorders or arrest, shortening or angular deformity, loss of motion and degenerative osteoarthritis. In accordance with what suggested in the literature, initial parenteral treatment followed early by oral antibiotics was chosen, with an excellent outcome.

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Meningococcal septicaemia can cause progressive necrosis of skin, soft tissue and bone. Successful limb reconstruction following the disease depends on an accurate assessment of the viability of these tissues and on a multidisciplinary team approach to ensure optimal care. However, bone scanning is not commonly performed in these patients. We present a case of meningococcal septicaemia where bone scanning significantly altered the management by demonstrating an extensive area of bone necrosis proximal to the soft-tissue necrosis. In view of this finding, we propose that bone scanning should be considered in all cases of meningococcal septicaemia where there is tissue necrosis affecting a limb, and that the radiologist should be considered a vital member of the multidisciplinary team.

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The studies made showed that one-tenth patient with purulent meningoencephalitis (PME) needs to be examined by axial computerized tomography (ACT) techniques. The following items are indications for ACT: apparent or progressive neurological symptomatology, protracted or relapsing course of PME, formation of the intracranial liquor hypertension, apparent changes in echoencephalography, and congestive disorders in the eyegrounds. Brain ACT permits finding a relevant policy of treating patients (surgery or conservative option) together with predicting the course and outcome of PME.

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A 60-yr-old immunodepressed woman presented with acute perimyocarditis and cardiac tamponade complicating meningococcic infection. We had the opportunity to study her cardiac condition by injecting antimyosin during the acute phase. Images at 48 hr showed unexpected findings, with obvious localization of the tracer in the pericardial fluid, as well as myocardial uptake. Possible mechanisms for pericardial activity are discussed.

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Technetium bone scintigraphy was performed in four patients with fulminant meningococcemia and extensive peripheral gangrene. The bone scans showed variable levels of absent uptake in all extremities of the four patients who subsequently required quadrimembral amputations. In 13 limbs, the level of amputation was determined primarily by the bone scan findings, and operation was successful in 84% of those limbs. These findings suggest that bone scanning is a useful adjunct in differentiating viable from nonviable tissues in patients with extensive peripheral gangrene secondary to fulminant meningococcemia and thus helps determine the appropriate level of amputation in such patients.

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Waterhouse-Fridericksen syndrome is a rare possibility in the adult. The case reported here included full radiological evaluation. The diagnosis was made by ultrasonographic and CT scan imaging. Nuclear magnetic resonance imaging was obtained for the purposes of documentation.

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Three cases of pneumonia caused by Neisseria meningitidis group Y are reported. From the results of these cases, the following conclusions were made. N. meningitidis probably can cause serious infection without preceding blood stream invasion. Primary meningococcal pneumonia is not rare; it has no distinctive clinical presentation; and it may not be recognized by routine expectorated sputum cultures. In addition, it may be associated with recent influenzal and adenoviral infections. Lastly, meningococci of the serogroup Y are capable of causing serious disease. Antimicrobial susceptibility studies showed that all three group Y isolates were sensitive to sulfadiazine and rifampin as well as to penicillin, ampicillin, erythromycin, and chloramphenicol.

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