{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:11:02Z","timestamp":1790143862327,"version":"4.0.1"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Objectives<\/jats:title>\n Complement C5 inhibitors such as ravulizumab are increasingly used for acetylcholine receptor\u2013positive generalized myasthenia gravis (MG) but confer a relevant risk of invasive meningococcal infection. We report a rare case of fulminant meningococcal meningitis despite complete vaccination, highlighting the limits of current preventive strategies.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Case report<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A 41-year-old woman with acetylcholine receptor\u2013positive MG was treated with ravulizumab after two-dose series meningococcal vaccination (MenACWY and MenB). One month after therapy initiation, she presented with nausea, vomiting and rapidly developed impaired consciousness. CSF showed neutrophilic pleocytosis, hypoglycorrhachia, and high lactate, consistent with bacterial meningitis. Rapid testing and culture confirmed\n Neisseria meningitidis serotype Y<\/jats:italic>\n . Despite immediate broad-spectrum antibiotics, neurological deterioration required intubation and intensive care. The patient recovered after 18 days of intravenous antibiotics and was switched from ravulizumab to rozanolixizumab.\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n This case illustrates that vaccination does not abolish the risk of fulminant meningococcal infection under complement inhibition. Awareness, patient information, and rapid initiation of antibiotics are critical. Clinicians should counsel patients and relatives that meningitis may occur despite vaccination and promote early recognition strategies.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1943514","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:50:25Z","timestamp":1790142625000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Fulminant meningococcus-meningitis under treatment with ravulizumab despite complete vaccination\u2014a rare but severe complication"],"prefix":"10.3389","volume":"13","author":[{"given":"G\u00e1bor","family":"Koz\u00e1k","sequence":"first","affiliation":[{"name":"Department for Vascular Neurology, Centre for Neurology, University of T\u00fcbingen","place":["T\u00fcbingen, Germany"]},{"name":"Hertie-Institute for Clinical Brain Research, University of T\u00fcbingen","place":["T\u00fcbingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"F\u00f6rster","sequence":"additional","affiliation":[{"name":"Department for Vascular Neurology, Centre for Neurology, University of T\u00fcbingen","place":["T\u00fcbingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Haap","sequence":"additional","affiliation":[{"name":"Department of Medicine, Medical Intensive Care Unit, University Hospital T\u00fcbingen","place":["T\u00fcbingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reimer","family":"Riessen","sequence":"additional","affiliation":[{"name":"Department of Medicine, Medical Intensive Care Unit, University Hospital T\u00fcbingen","place":["T\u00fcbingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"B\u00f6hm-Gonzalez","sequence":"additional","affiliation":[{"name":"Department for Epileptology, Centre for Neurology, University of T\u00fcbingen","place":["T\u00fcbingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Hendrik","family":"Stahl","sequence":"additional","affiliation":[{"name":"Department for Epileptology, Centre for Neurology, University of T\u00fcbingen","place":["T\u00fcbingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Grimm","sequence":"additional","affiliation":[{"name":"Department for Epileptology, Centre for Neurology, University of T\u00fcbingen","place":["T\u00fcbingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Ziemann","sequence":"additional","affiliation":[{"name":"Department for Vascular Neurology, Centre for Neurology, University of T\u00fcbingen","place":["T\u00fcbingen, Germany"]},{"name":"Hertie-Institute for Clinical Brain Research, University of T\u00fcbingen","place":["T\u00fcbingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siri","family":"G\u00f6pel","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine I, University Hospital T\u00fcbingen","place":["T\u00fcbingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josua","family":"Kegele","sequence":"additional","affiliation":[{"name":"Department for Epileptology, Centre for Neurology, University of T\u00fcbingen","place":["T\u00fcbingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annerose","family":"Mengel","sequence":"additional","affiliation":[{"name":"Department for Vascular Neurology, Centre for Neurology, University of T\u00fcbingen","place":["T\u00fcbingen, Germany"]},{"name":"Hertie-Institute for Clinical Brain Research, University of T\u00fcbingen","place":["T\u00fcbingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Feil","sequence":"additional","affiliation":[{"name":"Department for Vascular Neurology, Centre for Neurology, University of T\u00fcbingen","place":["T\u00fcbingen, Germany"]},{"name":"Hertie-Institute for Clinical Brain Research, University of T\u00fcbingen","place":["T\u00fcbingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s12882-020-02190-0","article-title":"Efficacy and safety of the long-acting C5 inhibitor ravulizumab in patients with atypical hemolytic uremic syndrome triggered by pregnancy: a subgroup analysis","volume":"22","author":"G\u00e4ckler","year":"2021","journal-title":"BMC 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