Fulminant bacterial meningitis due to Neisseria meningitidis nwith no pleocytosis on lumbar puncture

Bacterial meningitis is a serious, acute infection of the meninges. Definitive diagnosis is made by analysis of cerebral spinal fluid (CSF) culture. Diagnostic clues of bacterial meningitis on the CSF include pleocytosis, an elevation in thewhite blood cell(WBC) count. We report a 3-year-old white male who presented to the emergency department (ED) secondary to two febrile seizures. He was ultimately diagnosed with fulminant bacterialmeningitis secondary to CSF culture confirmed Neiserriameningitidis. The patient's CSF obtained on admission to the ED did not have pleocytosis. Within 5 hours of initial presentation, he became hypotensive, altered andwent into disseminated intravascular coagulation. He expired within 24 hours of presentation. Bacterial meningitis without CSF pleocytosis, later determined to be culture positive, has been reported in both adult and pediatric patients but is extremely rare. However, these patients are more likely to have poorer outcomes. If bacterial meningitis is suspected, empiric antibiotics should be administered regardless of initial WBC count on lumbar puncture.