Invasive Meningococcal Disease Presenting as Sepsis in Late Pregnancy: Case report ARTICLE TYPE: A case report

Invasive Meningococcal Disease Presenting as Sepsis in Late Pregnancy: Case report ARTICLE TYPE: A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Invasive Meningococcal Disease Presenting as Sepsis in Late Pregnancy: Case report ARTICLE TYPE: A case report Maria Alaciel Galvan Merlos, Diana Paulina Leonel Lozada, Joana Mairamy Peralta Castro, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9712613/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Invasive meningococcal disease (IMD) is a rapidly progressive and potentially fatal infection caused by Neisseria meningitidis, characterized by a broad clinical spectrum ranging from meningitis to fulminant meningococcemia. Early diagnosis remains challenging, particularly in atypical presentations and in special populations such as pregnant patients. Case Presentation: We report the case of a 27-year-old previously healthy woman at 31.6 weeks of gestation who presented with an acute febrile illness associated with non-blanching petechial rash and systemic inflammatory response. Initial evaluation revealed marked leukocytosis with neutrophilia, elevated inflammatory markers (CRP and procalcitonin), and early coagulation abnormalities. Given the endemic context, arboviral infection was initially considered; however, the hematologic profile suggested a bacterial etiology. The patient was admitted to the intensive care unit for close monitoring due to the high risk of rapid deterioration. Blood cultures and cerebrospinal fluid (CSF) analysis confirmed Neisseria meningitidis, with CSF findings diagnostic of acute bacterial meningitis, including pleocytosis, neutrophilic predominance, hypoglycorrhachia, and hyperproteinorrachia. Early targeted antimicrobial therapy with ceftriaxone and multidisciplinary management, including obstetric surveillance, were initiated. Results: The patient remained hemodynamically stable throughout hospitalization and demonstrated progressive clinical and laboratory improvement without progression to septic shock, disseminated intravascular coagulation, or neurological complications. Cutaneous lesions resolved without necrosis or purpura fulminans. The pregnancy continued without obstetric complications, and both maternal and fetal outcomes were favorable. Conclusion: This case highlights the importance of early recognition of meningococcal disease in patients presenting with fever and petechial rash, even in the absence of classical neurological signs. Prompt diagnosis, early antimicrobial therapy, and intensive multidisciplinary management are critical to improving outcomes, particularly in high-risk populations such as pregnant patients. IMD should remain a key differential diagnosis in acute febrile syndromes with cutaneous manifestations, especially in regions where viral infections are endemic. Invasive meningococcal disease Neisseria meningitidis meningococcemia bacterial meningitis pregnancy petechial rash sepsis critical care cerebrospinal fluid differential diagnosis Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9712613","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":640323895,"identity":"2c394c5a-9a24-4c7f-987e-9ea2ce395053","order_by":0,"name":"Maria Alaciel Galvan Merlos","email":"","orcid":"","institution":"National Autonomous University of Mexico","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"Alaciel Galvan","lastName":"Merlos","suffix":""},{"id":640323904,"identity":"0f9ef2a4-2141-4ca5-9f08-a5f0c082520b","order_by":1,"name":"Diana Paulina Leonel Lozada","email":"","orcid":"","institution":"National 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petechial rash, sepsis, critical care, cerebrospinal fluid, differential diagnosis","lastPublishedDoi":"10.21203/rs.3.rs-9712613/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9712613/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eInvasive meningococcal disease (IMD) is a rapidly progressive and potentially fatal infection caused by Neisseria meningitidis, characterized by a broad clinical spectrum ranging from meningitis to fulminant meningococcemia. Early diagnosis remains challenging, particularly in atypical presentations and in special populations such as pregnant patients.\u003c/p\u003e\n\u003cp\u003eCase Presentation: We report the case of a 27-year-old previously healthy woman at 31.6 weeks of gestation who presented with an acute febrile illness associated with non-blanching petechial rash and systemic inflammatory response. Initial evaluation revealed marked leukocytosis with neutrophilia, elevated inflammatory markers (CRP and procalcitonin), and early coagulation abnormalities. Given the endemic context, arboviral infection was initially considered; however, the hematologic profile suggested a bacterial etiology. The patient was admitted to the intensive care unit for close monitoring due to the high risk of rapid deterioration. Blood cultures and cerebrospinal fluid (CSF) analysis confirmed Neisseria meningitidis, with CSF findings diagnostic of acute bacterial meningitis, including pleocytosis, neutrophilic predominance, hypoglycorrhachia, and hyperproteinorrachia. Early targeted antimicrobial therapy with ceftriaxone and multidisciplinary management, including obstetric surveillance, were initiated.\u003c/p\u003e\n\u003cp\u003eResults: The patient remained hemodynamically stable throughout hospitalization and demonstrated progressive clinical and laboratory improvement without progression to septic shock, disseminated intravascular coagulation, or neurological complications. Cutaneous lesions resolved without necrosis or purpura fulminans. The pregnancy continued without obstetric complications, and both maternal and fetal outcomes were favorable.\u003c/p\u003e\n\u003cp\u003eConclusion: This case highlights the importance of early recognition of meningococcal disease in patients presenting with fever and petechial rash, even in the absence of classical neurological signs. Prompt diagnosis, early antimicrobial therapy, and intensive multidisciplinary management are critical to improving outcomes, particularly in high-risk populations such as pregnant patients. IMD should remain a key differential diagnosis in acute febrile syndromes with cutaneous manifestations, especially in regions where viral infections are endemic.\u003c/p\u003e","manuscriptTitle":"Invasive Meningococcal Disease Presenting as Sepsis in Late Pregnancy: Case report ARTICLE TYPE: A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-15 11:56:33","doi":"10.21203/rs.3.rs-9712613/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fa33599d-8577-45c9-a3d8-c63bb66eccca","owner":[],"postedDate":"May 15th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-15T04:18:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-14T12:54:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-14T12:06:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"Infection","date":"2026-05-14T09:25:47+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-17T13:20:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-15 11:56:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9712613","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9712613","identity":"rs-9712613","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}