Fulminant Meningococcemia Presenting as Acute Abdomen Without Meningeal Signs: A Report of Two Cases and Review of Atypical Presentations.

Fulminant meningococcemia classically presents with meningitis or septicemia accompanied by rash and meningeal signs. However, atypical presentations dominated by gastrointestinal symptoms may delay diagnosis and increase mortality. We report two cases of microbiologically confirmed meningococcemia in young, previously healthy adults presenting primarily with acute gastrointestinal symptoms and abdominal pain, without rash or meningeal signs. The first case involved a 31-year-old man presenting with acute abdomen, septic shock, and multiorgan dysfunction who survived following early microbiological diagnosis and prompt antimicrobial therapy. The second case involved a 22-year-old man presenting with vomiting and septic shock who rapidly deteriorated and succumbed despite early resuscitation. Blood cultures in both cases grew Neisseria meningitidis serogroup W135.