Meningococcemia

Sudden fever with severe limb pain, vomiting or diarrhea, cold extremities, altered mental status, or a new nonblanching petechial or purpuric rash is a time-critical pattern, not a routine febrile illness. Meningococcemia can deteriorate before a complete history, lumbar puncture, or laboratory confirmation is available. Place the patient on droplet precautions, call for emergency support, obtain cultures if doing so will not slow treatment, and administer empiric ceftriaxone or cefotaxime promptly. The mechanism below explains why shock, bleeding, and skin injury can appear together.