Musculoskeletal infection with nongonococcal Neisseria species not associated with meningitis

Five patients with type III musculoskeletal infection from nongonococcal Neisseria species were examined during a 13-month period. The initial clinical diagnosis was incorrect in all cases. Synovial fluid analysis and Gram's stain were not helpful, and the correct diagnosis was made only after culture reports were available. The patients responded well to antibiotic treatment, but two patients with underlying rheumatoid arthritis required surgical debridement. All patients were asymptomatic, with resolution of their infection at follow-up evaluation. An early correct diagnosis is mandatory and Neisseria infection should be considered in patients with pre-existing joint disease.