A 7-year-old girl was admitted to the emergency department with a 2-week history of fever and general weakness. She had been diagnosed with tetralogy of Fallot and received surgical repair. Pulmonary prosthetic valve replacement was performed in January 2014 because of severe pulmonary regurgitation and moderate right ventricle dilatation. Echocardiography revealed suspicious vegetation around the prosthetic pulmonary valve. Neisseria cinerea was confirmed in blood culture. We diagnosed with bacterial infective endocarditis, and administered empirical intravenous antibiotics for endocarditis. However, the fever and general weakness continued, with mild muscle aches and coughing. Thus, we performed a chest radiography and pneumonia workup. Therefore, she was diagnosed with mycoplasma pneumonia and given oral clarithromycin twice daily for 2 weeks. She was successfully treated with antibiotics for 46 days. We report the first case of infective endocarditis caused by N. cinerea in Korea.
Anti-Bacterial Agents ; Child* ; Clarithromycin ; Cough ; Dilatation ; Echocardiography ; Emergency Service, Hospital ; Endocarditis* ; Female* ; Fever ; Heart Ventricles ; Humans ; Korea ; Neisseria cinerea* ; Neisseria* ; Pneumonia ; Pneumonia, Mycoplasma ; Pulmonary Valve Insufficiency ; Pulmonary Valve* ; Radiography ; Tetralogy of Fallot ; Thorax

Neisseria cinerea is an oropharyngeal normal flora known as a non-pathogenic gram-negative diplococcus. Encephalo-meningitis related to N. cinerea is very rare. A 15-year-old healthy male visited emergency room for altered mentality with fever, headache, and vomiting. Physical examination showed abdominal tenderness and neck stiffness but there was no skin rash. Cerebrospinal fluid (CSF) examination revealed opening pressure of 210 mmH2O, red blood cell 200/mm3, white blood cell 8,320/mm3, neutrophil 84%, glucose 34 mg/dL, suggesting acute bacterial meningitis. Empirical antibiotics were administered and N. cinerea was identified in CSF culture. The patient showed complete recovery 10 days after administration of ceftriaxone. We report this case as the first N. cinerea meningitis in Korea.
Adolescent ; Anti-Bacterial Agents ; Ceftriaxone ; Cerebrospinal Fluid ; Emergency Service, Hospital ; Erythrocytes ; Exanthema ; Fever ; Glucose ; Headache ; Humans ; Korea ; Leukocytes ; Male ; Meningitis ; Meningitis, Bacterial* ; Neck ; Neisseria cinerea* ; Neutrophils ; Physical Examination ; Vomiting

Neisseria cinerea is bacteria known as non-pathogenic strain. However, in rare cases, it can cause opportunistic infections. Those diseases caused by N. cinerea include neonatal ophthalmia, proctitis, pneumonia, peritonitis in patients with continuous ambulatory peritoneal dialysis, endocarditis and meningitis. In this report, we describe a patient with septic arthritis and skin abscess of finger joints that was caused by N. cinerea. A 27-year-old man visited the hospital due to swelling, redness and pain of proximal interphalangeal joint of the left second finger. After blood culture test, ceftriaxone was administered on admission and debridement was performed the affected joints. N. cinerea was identified in the blood culture. The patient was improved with ceftriaxone.
Abscess* ; Adult ; Arthritis, Infectious* ; Bacteria ; Ceftriaxone ; Debridement ; Endocarditis ; Endophthalmitis ; Finger Joint ; Fingers ; Humans ; Joints ; Meningitis ; Neisseria cinerea* ; Opportunistic Infections ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Pneumonia ; Proctitis ; Skin* ; Soft Tissue Infections