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Background: Primary meningococcal arthritis (PMA) is defined as the presence of acute septic arthritis with the identification of Neisseria meningitidis in synovial fluid or blood cultures but no clinical evidence of sepsis or meningitis. This report aimed to describe a clinical case of PMA caused by serogroup W, an uncommon etiology of this disease in Uruguay, and review the available literature. Case report: We report the case of a 5-year-old female, with no past medical history, admitted to the emergency department with a 12-hour history of fever of 39 °C and a limp. The patient was hemodynamically stable and had no clinical evidence of meningitis. Hip ultrasound showed an increase in synovial fluid. Arthrocentesis showed purulent exudate and synovial fluid culture showed no growth after five days. The blood culture showed isolates of N. meningitidis, serogroup W. The patient received treatment with ceftriaxone, and drainage of the affected joint was performed with excellent clinical response. Conclusions: Primary meningococcal arthritis is a rare presentation of meningococcal disease. Systematic arthrocentesis and the adequacy of antibiotic therapy when septic arthritis is clinically suspected are essential for confirming the diagnosis and decompressive drainage of the involved joint. This report is the first of PMA caused by serogroup W in Uruguay. Although the most common serogroup involved in meningococcal arthritis is serogroup B in Uruguay, an increase in serogroup W-related diseases has been reported in Chile and Argentina, emphasizing the need for epidemiological surveillance.

En los lactantes, el déficit de vitamina B12 se debe fundamentalmente a carencias nutricionales vinculadas a déficit materno. La mayoría de los casos de déficit materno se vinculan a dietas vegetarianas. La anemia perniciosa es una enfermedad autoinmune que compromete la absorción de esta vitamina, aunque menos frecuente que la carencia nutricional, es también una causa importante de déficit materno. Objetivo: reportar un caso de déficit de vitB12 en un lactante, secundario a anemia perniciosa en su madre, y revisar los aspectos más importantes de esta enfermedad en la infancia. Caso Clínico: Lactante de 9 meses, de sexo masculino, sin antecedentes perinatales patológicos, alimentado con lactancia materna, con rechazo persistente a la incorporación de alimentos sólidos desde los 6 meses. Un mes previo a la consulta, comenzó progresivamente con hiporreactividad, con fluctuación del estado de conciencia, regresión de conductas motoras y vómitos. El hemograma mostró anemia macrocítica y neutropenia. Se confirmó el déficit de vitamina B12 en el lactante. Recibió tratamiento con vitamina B12 intramuscular con buena evolución clínica y de los exámenes de laboratorio. Se confirmó el déficit materno de B12 como causa del déficit en el lactante. No existían restricciones en la dieta materna, por lo que se midieron en la madre los anticuerpos anti factor intrínseco y anti célula parietal que resultaron positivos, diagnosticándose anemia perniciosa. Conclusiones: El reconocimiento precoz es fundamental para prevenir el desarrollo de daño neurológico potencialmente irreversible. La anemia perniciosa materna debe ser considerada en el caso de niños con anemia megaloblástica, principalmente en aquellos cuyas madres no tengan dietas vegetarianas.

In infants, vitamin B12 deficiency is mainly due to nutritional deficiencies related to maternal deficit. Most cases of maternal deficiencies are associated with vegetarian diets. Pernicious anemia is an au toimmune disease that affects the absorption of this vitamin. Although it is less common than nutri tional deficiency, is also an important cause of maternal deficiency.to report a case of an infant with vitB12 deficiency, secondary to pernicious anemia in his mother, and to review the most important aspects of this disease in childhood.Nine months-old male infant, without pathological perinatal history, exclusively breastfed, with persistent rejection of solid food from 6 months of age. One month before hospitalization, he progressively presented hyporesponsiveness, with fluctuating state of alertness, regression of motor development milestones, and vomiting. The blood count showed macrocytic anemia and neutropenia. Vitamin B12 deficiency was confirmed in the patient. He received treatment with intramuscular vitamin B12 with good clinical and laboratory response. Maternal B12 deficiency was confirmed as the cause of the infant's deficiency. Since the mother reported no dietary restrictions, anti-intrinsic factor and anti-parietal cell antibodies were measured, leading to the diagnosis of pernicious anemia.Early recognition is essential to prevent the development of potentially irreversible neurological damage. Maternal pernicious ane mia should be considered in children with megaloblastic anemia, especially in those whose mothers do not follow vegetarian diets.