A Rare Cause of Preseptal Cellulitis: Neisseria meningitidis

İngilizce (OpenAlex)

To the Editors: Inflammation of the eyelids and periorbital tissues without signs of orbital involvement is termed periorbital or preseptal cellulitis.1 It is a common condition, usually in young children under 5 years of age. Data on microorganisms causing preseptal cellulitis are limited. Herein, a case of Neisseria meningitidis, which is often overlooked as a possible cause of preseptal cellulitis, is presented. A 6-month-old female patient presented with erythematous edema of the upper and lower eyelids with purulent discharge in the right eye for 1 day without a history of trauma, upper respiratory tract infection or sinusitis. There were no distinctive features in her medical history. Her vaccination history was compatible with her age. Systemic examination was normal; there was no sign of meningeal irritation. The ophthalmologic evaluation of the right eye revealed erythematous edema and warmth of the upper and lower eyelid and conjunctival hyperemia with purulent discharge (Fig. 1). Proptosis was absent, and the pupillary reactions were normal with normal ocular movements. The examination of the left eye was normal.FIGURE 1.: Erythematous edema of the upper and lower eyelid and conjunctival hyperemia with purulent discharge.In laboratory tests, white blood cell count was 13.200/mm3 (39.9% neutrophil), hemoglobin was 13 g/dL, platelet count was 415.000/mm3 and C-reactive protein was 1.8 mg/L. Blood electrolytes, liver and kidney functions were normal. The conjunctival culture was performed. The patient was hospitalized and ampicillin-sulbactam was initiated with the diagnosis of preseptal cellulitis. N. meningitidis serogroup B grew in the conjunctival culture (Gram stain: Gram-negative diplococci, 4–5 neutrophil). The susceptibility test showed that the microorganism was sensitive to ceftriaxone. Peripheral blood culture was negative. The patient’s symptoms improved quickly after treatment was revised to ceftriaxone, and he was discharged after 7 days of treatment. Preseptal cellulitis is an infection of the subcutaneous tissues anterior to the orbital septum. It rarely leads to serious complications.1 There are various causes of preseptal cellulitis: spread from adjacent structures which is common in the pediatric age group, direct inoculation after eyelid trauma or insect bites and hematogenous spread from an upper respiratory tract infection.1 Preseptal cellulitis is a rare presentation of Neisseria infection, with few cases reported in the literature.2 The spectrum of skin and soft tissue involvement in meningococcal disease is quite wide. It includes a petechial or ecchymotic rash that can develop into palpable purpura, macular, papular and pustular lesions, necrotizing fasciitis and acute cellulitis.3 Few cases of preseptal cellulitis caused by N. meningitidis have been reported in the pediatric literature.2,4 One of these children was presented with meningococcal meningitis.4 Acute conjunctivitis caused by N. meningitidis is rare but it is potentially dangerous. It can be seen with systemic meningococcal infection or as primary meningococcal conjunctivitis. Cases of meningococcal conjunctivitis and preseptal cellulitis without invasive infection are even extremely infrequent. It is essential to perform conjunctival swab sampling in case of conjunctivitis associated with preseptal cellulitis before starting an empiric antibiotic treatment. N. meningitidis should be kept in mind as a possible causative agent in patients diagnosed with preseptal cellulitis and acute or hyperacute purulent conjunctivitis. Culture of purulent discharge is mandatory for diagnosis.