Presumed Meningococcal meningitis with Waterhouse–Friderichsen syndrome from a rural Ethiopia: a fatal case report and literature review

Introduction and importance: Meningitis is a significant global health threat, affecting millions and causing numerous deaths each year. Neisseria meningitides disproportionately affects resource-poor countries. Waterhouse–Friderichsen syndrome (WFS), a severe complication involving endotoxin-mediated adrenal damage, further worsens patient outcomes. Case presentation: A 35-year-old unvaccinated woman from Garbo, Somali, Ethiopia presented with a 24-hour history of fever, headache, and neck pain, progressing to altered mental status, right-sided weakness, and respiratory distress. Examination revealed confusion, respiratory distress, hypotension, tachycardia, and widespread non-blanching purpura, and right-sided weakness (3/5). Investigations showed leukocytosis, thrombocytopenia, and impaired renal function. The patient received supportive care with oxygen, fluid resuscitation, empiric antibiotics, epinephrine, and hydrocortisone. However, she continued to deteriorate and she ultimately expired with a presumed diagnosis of complicated Meningococcal meningitis with WFS. Clinical discussion: M. meningitis with suspected WFS is a medical emergency requiring prompt action. Resource-limited settings present challenges, leading to poor outcomes, as seen in this case. Meningococcal disease varies in severity, but its rapid progression is a key. Meningococcemia presents with fever, headache, and a non-blanching rash. WFS, a severe complication, involves shock, rash, and multiorgan failure. Diagnosing M. meningitis involves routine tests and definitive diagnosis relies on isolating the bacteria. Treatment includes prompt antibiotics and supportive treatment. Conclusion: M. meningitis , a deadly infection when complicated by WFS, demands urgent action. This case underscores the critical need for improved diagnostics, treatment protocols, and healthcare infrastructure in resource-limited settings to prevent fatalities and serves as a benchmark for addressing these challenges.