抄録
We report a rare case of keratoconjunctivitis in a young Japanese man rapidly identified as Neisseria meningitidis by MALDI-TOF MS (matrix-assisted laser desorption-ionization time-of-flight mass spectrometry). The patient was diagnosed with primary meningococcal conjunctivitis. A 26-year-old man presented to Osaka Medical and Pharmaceutical University with a 3-day history of sudden pain onset in both eyes, conjunctival redness, tearing, and purulent eye discharge. The bulbar and palpebral conjunctiva were hyperemic and thickened, with superficial punctate keratitis in both eyes, and an area of stromal infiltration in the left eye. No epithelial defects or corneal thinning were observed. He had a slight fever and fatigue. Initial Gram staining of the conjunctiva revealed gram-negative diplococci, and, he had a sexual encounter two weeks ago, therefore, we suspected gonococcal conjunctivitis. The patient was administered with 1 g of intravenous ceftriaxone every 12 h for 7 days, and topical cefmenoxime hydrochloride and topical gatifloxacin hydrate were administered eight times per day. His condition improved dramatically after treatment; however, on the third day after admission, Neisseria meningitidis was detected through conjunctival swab culture and biochemical testing using the VITEKⓇ2 NH card. We also rapidly identified Neisseria meningitidis through conjunctival swab mass spectrometry using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Later, the same bacterium was detected through genetic analyses. Following advice from our hospital’s infectious disease control office, our patient was isolated in a private room for 1 week, and individuals who were in close contact with him were administered ciprofloxacin tablets. We strongly suspected gonococcal infection and initiated treatment, but Neisseria meningitidis was rapidly identified using conjunctival swab MALDI-TOF MS analysis. Therefore, appropriate treatment and infection prevention measures were possible.
