{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T05:53:22Z","timestamp":1767678802425,"version":"3.48.0"},"reference-count":12,"publisher":"BMJ","issue":"1","funder":[{"name":"Department of Medicine, Suratthani Hospital"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,12,20]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    We describe a culture-confirmed case of severe meningococcaemia initially resembling severe leptospirosis, characterised by sepsis, purpura fulminans, meningitis and multiorgan failure. In a tropical setting where leptospirosis is endemic, overlapping clinical features might obscure diagnosis, particularly when facing uncertainty in rapid serological testing interpretation and atypical cerebrospinal fluid findings. Although the patient twice tested positive for rapid\n                    <jats:italic>Leptospira<\/jats:italic>\n                    IgM, blood culture ultimately confirmed\n                    <jats:italic>Neisseria meningitidis<\/jats:italic>\n                    . Early administration of appropriate antibiotics and supportive care was life-saving, but complications such as dry gangrene and severe renal injury developed. This case highlights the diagnostic challenge of distinguishing meningococcaemia from other tropical infections. It highlights the importance of microbiological confirmation, timely isolation with chemoprophylaxis for close contacts and multidisciplinary follow-up for long-term sequelae.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2025-270817","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T05:50:20Z","timestamp":1767678620000},"page":"e270817","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Severe meningococcaemia mimicking leptospirosis: a diagnostic challenge in a tropical setting"],"prefix":"10.1136","volume":"19","author":[{"given":"Kantimon","family":"Kwanchouy","sequence":"first","affiliation":[{"name":"Internal Medicine, Suratthani Hospital, Muang, Surat Thani, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jintana","family":"Srisompong","sequence":"additional","affiliation":[{"name":"Infectious Medicine, Department of Internal Medicine, Suratthani Hospital, Muang, Surat Thani, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3353-2033","authenticated-orcid":false,"given":"Thotsaporn","family":"Morasert","sequence":"additional","affiliation":[{"name":"Pulmonary and Critical Care Medicine, Department of Internal Medicine, Suratthani Hospital, Muang, Surat Thani, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"2026010521501096000_19.1.e270817.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2020.07.025"},{"key":"2026010521501096000_19.1.e270817.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003898","article-title":"Global Morbidity and Mortality of Leptospirosis: A Systematic Review","volume":"9","author":"Costa","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"2026010521501096000_19.1.e270817.3","doi-asserted-by":"crossref","first-page":"567","DOI":"10.2169\/internalmedicine.55.3272","article-title":"Meningococcemia in Adults: A Review of the Literature","volume":"55","author":"Takada","year":"2016","journal-title":"Intern Med"},{"key":"2026010521501096000_19.1.e270817.4","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1016\/j.apjtm.2017.10.004","article-title":"Meningococcal disease, a clinical and epidemiological review","volume":"10","author":"Batista","year":"2017","journal-title":"Asian Pac J Trop Med"},{"key":"2026010521501096000_19.1.e270817.5","unstructured":"Perera TB , Heather M M-L . Purpura fulminans. In: Statpearls. 2025. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK532865\/"},{"key":"2026010521501096000_19.1.e270817.6","doi-asserted-by":"crossref","DOI":"10.4103\/0378-6323.93655","article-title":"Spectrum of purpura fulminans: report of three classical prototypes and review of management strategies","volume":"78","author":"Talwar","year":"2012","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"2026010521501096000_19.1.e270817.7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0012174","article-title":"Accuracy of rapid lateral flow immunoassays for human leptospirosis diagnosis: A systematic review and meta-analysis","volume":"18","author":"Nualnoi","year":"2024","journal-title":"PLoS Negl Trop Dis"},{"key":"2026010521501096000_19.1.e270817.8","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-99377-8","article-title":"Evaluation of a genus-specific rGroEL1-524 IgM-ELISA and commercial ELISA kits during the course of leptospirosis in Thailand","volume":"11","author":"Maneewatchararangsri","year":"2021","journal-title":"Sci Rep"},{"key":"2026010521501096000_19.1.e270817.9","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.14.2.296-326.2001"},{"key":"2026010521501096000_19.1.e270817.10","article-title":"Meningococcal Sepsis Complicated by Symmetrical Peripheral Gangrene: A Case Report","volume":"12","author":"Ennis","year":"2020","journal-title":"Cureus"},{"key":"2026010521501096000_19.1.e270817.11","article-title":"Bilateral renal cortical necrosis in meningococcal meningitis","volume":"2011","author":"Kennedy","year":"2011","journal-title":"Case Rep Nephrol"},{"key":"2026010521501096000_19.1.e270817.12","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-023-00683-3"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-270817","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T05:50:22Z","timestamp":1767678622000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-270817"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,5]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bcr-2025-270817"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-270817","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}