A Woman with Fever and Abdominal Pain

This patient had a history of noncirrhotic portal hypertension due to schistosomiasis and had just visited rural Brazil. After her admission to the hospital, blood cultures initially grew bacteria identified as gram-positive cocci (see Figure 1, Panel A). Unfortunately, she rapidly developed shock and disseminated intravascular coagulation (DIC) and died. Re-examination of blood cultures with increased decolorization time showed gram-negative diplococci instead (see Figure 1, Panels B and C). Autopsy was consistent with disseminated infection due to N. meningitidis serogroup W.