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Meningococcal meningitis with septic shock — SCE Acute Medicine MCQ

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ModerateSepsis and Infectious EmergenciesMeningococcal meningitis with septic shockSCE Acute Medicine

A 24-year-old student presents with fever, severe headache and confusion. He has a purpuric rash on both legs, BP 88/50 mmHg and neck stiffness. Platelets are 62 x 10^9/L and INR is 1.7. CT is not immediately available. What is the most appropriate next step in management?

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Correct answer: A — Give immediate intravenous ceftriaxone and supportive sepsis care before lumbar puncture

This is suspected meningococcal sepsis with meningitis, shock and coagulopathy, so antibiotics and sepsis care must not wait for LP or CT. LP is unsafe with shock, coagulopathy and thrombocytopenia. Aciclovir may be added if encephalitis is suspected, but it does not cover meningococcus. The examination trap is over-prioritising diagnostic purity when immediate antibiotics are life-saving.

Reference: NICE NG240, UKHSA meningococcal disease guidance, BNF