LAUSR

C with functional or anatomic asplenia are at high risk for invasive meningococcal disease, especially with encapsulated strains. Nongroupable (unencapsulated) meningococcal strains, which are commonly associated with asymptomatic nasopharyngeal carriage and considered as nonpathogenic, rarely cause invasive disease. Herein, we report a rare case of meningococcemia due to nongroupable Neisseria meningitidis in a splenectomized child despite meningococcal vaccination. A 10-year-old female presented to the emergency department with acute onset fever, headache and myalgia. Her past medical history included splenectomy for trauma at the age of 9 years. The patient was started on penicillin prophylaxis and vaccinated with 2-dose series of MenACWY-TT and MenB-4C after splenectomy. On physical examination, the patient was found to be febrile to 39.4°C, tachycardic (110 beats/ min) and hypotensive (80/40 mm/Hg). A nonblanchable petechial rash was present on the patient’s abdomen, lower legs and arms. After blood and cerebrospinal fluid cultures were obtained, treatment with empirical intravenous ceftriaxone was started for presumed meningococcemia. Laboratory evaluation showed leukopenia (3600/mm), thrombocytopenia (88,000/mm), elevated C-reactive protein (48 mg/dL) and disseminated intravascular coagulation. Lumbar puncture revealed no evidence of meningitis. Due to persistent hypotension, resuscitation was initiated with intravenous fluids and inotropes, and the patient was transferred to pediatric intensive care unit. On day 2, N. meningitidis (sensitive to ceftriaxone, but resistant to penicillin with a minimum inhibitory concentration of 0.5 mg/L) growth was noted in blood culture, confirming the diagnosis of meningococcemia. The isolate was determined to be nongroupable by both slide agglutination for serogroups A, B, C, E, W, X, Y and Z (Remel, Lenexa, KS) and real-time PCR. She was treated with 10 days of intravenous ceftriaxone and made a full recovery without any sequelae. During