Published on October 31, 2025

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Differential Diagnosis

• Viral exanthem
• Acute meningococcemia
• Immunoglobulin A (IgA) vasculitis
• Infectious Mononucleosis
• Multisystem inflammatory syndrome (MIS-C)

Diagnosis

The correct diagnosis is acute meningococcemia, a fulminant bloodstream infection caused by Neisseria meningitidis. This condition carries a high mortality rate—estimated at 13%—even with prompt treatment. N. meningitidis is a leading cause of bacterial meningitis and sepsis in children and young adults and can present as meningitis, septicemia, or both.

Transmission occurs through close contact with respiratory droplets. The clinical course often begins with nonspecific viral-like symptoms and may progress rapidly to sepsis, neurologic deterioration, and multiorgan failure within 24 hours.

What to Look For

• Toxic appearance: high fever, tachycardia, hypotension
• Systemic symptoms: headache, vomiting, myalgias, nuchal rigidity, altered mental status
• Characteristic rash:
  • Over 50% of patients present with petechiae, often on the trunk and lower extremities; mucosal and conjunctival involvement is also possible.
  • Retiform purpura or palpable purpura suggests more advanced disease.
  • Petechial lesions correlate with thrombocytopenia and may indicate evolving disseminated intravascular coagulation (DIC).
  • In early disease, a maculopapular eruption mimicking viral exanthem may occur—non-pruritic and transient, sometimes resolving within hours.

Pearls for Urgent Care Management

•  Invasive meningococcal disease is a medical emergency.
•  Initiate prompt stabilization and immediate transfer to an emergency department.
•  Administer IV fluid resuscitation and collect blood cultures if resources allow.
•  If transport to definitive care is delayed beyond one hour, administer a single dose of  ceftriaxone.

Acknowledgment: Image and case presented by VisualDx (www.VisualDx.com/jucm).