Meningococcal disease: a case report and discussion of clinical presentation and management

Meningococcal disease caused by the gram negative diplococcus Neisseria meningitidis is a relatively common infectious disease in developing countries of Asia and Africa. Infection usually starts with a non-specific prodrome of fever, vomiting, malaise and lethargy followed by signs of septicemia and shock (tachycardia, tachypnea, cyanosis, oliguria, hypotension) and/or meningitis (stiff neck, headache, photophobia and impaired sensorium). Characteristic meningococcal rash may not appear early in the disease course, potentially delaying the diagnosis and institution of appropriate antibiotic therapy in the patient and isolation and chemoprophylaxis in close contacts. We present here a patient who presented with meningococcal shock associated with characteristic skin lesions of meningococcemia and discuss the clinical presentation and management. The importance of early identification of the characteristic skin lesions of meningococcemia and timely institution of appropriate antibiotic therapy is emphasized.