Fulminant serogroup B meningococcemia in an adolescent vaccinated against serogroups A and C: highlighting the serogroup B vaccination gap in China—a case report and literature review

BackgroundInvasive meningococcal disease (IMD) remains an acute clinical challenge associated with high mortality and permanent disability. Although routine immunization has successfully suppressed historical lineages, an expanding epidemiological shift toward serogroup B in specific regions has exposed a population vulnerability, given that protein-based serogroup B vaccines are excluded from China's National Immunization Program (NIP, historically referred to as EPI). We present a case that characterizes the clinical trajectory of this vaccination mismatch.Case presentationWe report a case of a 12-year-old boy from Guangdong Province, China, who had previously received vaccination against Neisseria meningitidis serogroups A and C. He presented with fever and a rapidly progressive purpuric rash. Within hours, his condition deteriorated to septic shock, disseminated intravascular coagulation (DIC), and multiple organ dysfunction syndrome (MODS), consistent with purpura fulminans. Blood cultures confirmed N. meningitidis serogroup B. Following aggressive intensive care support—including antibiotics, vasopressors, mechanical ventilation, plasma exchange, and continuous renal replacement therapy—the patient survived, exhibiting complex ischemic sequelae that secondary cutaneous necrosis necessitated multi-stage surgical autologous grafting, which subsequently resulted in long-term functional extremity deficits.ConclusionThis case underscores the hyperacute progression of serogroup B meningococcemia in an adolescent previously immunized against serogroups A and C. The clinical course illustrates an individual vulnerability under the current polysaccharide-based framework and highlights the public health relevance of reassessing regional vaccine strategies and enhancing surveillance for emerging serogroups.