SHM Converge Scientific Abstract ePoster Gallery-Meningococcemia and Meningococcal Pneumonia With Recent Religious Tourism to Jerusalem

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A 70-year-old unvaccinated man developed acute-on-chronic cough, dyspnea, chills, pleuritic chest pain, and mild hypoxemia after returning from Jerusalem, where he had attended multiple large religious gatherings four months earlier. Initial workup showed a left lung consolidation consistent with pneumonia, normal lactate, and a negative respiratory viral/bacterial panel. He was admitted with hypoxemic respiratory failure and started on ceftriaxone and azithromycin.

Blood cultures later grew gram-negative diplococci and were identified as <strong>Neisseria meningitidis</strong>, prompting an increase in ceftriaxone dosing because of concern for possible meningitis. Although the patient briefly reported photophobia and headache, repeated exams did not reveal meningeal signs, and lumbar puncture was not performed because antibiotics had already been started before meningitis was strongly considered. His respiratory status improved rapidly, and he no longer required supplemental oxygen by hospital day 4. He completed 7 days of ceftriaxone and 3 days of azithromycin and was discharged without signs of meningitis.

The case highlights that <strong>meningococcal disease is now uncommon in the U.S.</strong>, but can still occur as meningococcemia or, rarely, primary pneumonia—especially in older adults. Travel and participation in religious gatherings in the Middle East may increase exposure risk, as carriage rates and outbreaks of meningococcal disease are higher in some regions. The patient’s lack of meningococcal vaccination likely contributed to his infection.

The report emphasizes two key points: first, meningococcal vaccination should be considered for travelers engaged in religious tourism to higher-risk regions; second, prompt blood-culture collection and early broad-spectrum intravenous antibiotics can lead to good outcomes even in unusual presentations such as meningococcal pneumonia.

Asset Subtitle

Matthew R. Kennis

Meta Tag

Author List Andrés Henao-Martinez, Charles Kim, Matthew R. Kennis

Category Clinical Vignettes

Concept Neisseria meningitidis

Concept Meningococcal vaccination

Concept Meningococcemia

Concept Meningococcal pneumonia

Concept Invasive meningococcal disease

Distinguished Non-Finalist

Presenter Organization University of Colorado Anschutz Medical Campus

Presenting Author Matthew R. Kennis

Track Adult

Keywords

Neisseria meningitidis

meningococcal pneumonia

blood cultures

ceftriaxone

hypoxemic respiratory failure

religious travel

Jerusalem

unvaccinated

older adults

meningococcal vaccination

Neisseria meningitidis

Meningococcal vaccination

Meningococcemia

Meningococcal pneumonia

Invasive meningococcal disease