A 36-year-old woman with no medical or epidemiological history of interest was admitted to the Intensive Care Unit for sepsis and meningitis due to type B meningococcus isolated in blood and cerebrospinal fluid cultures. She received fluid therapy support, ceftriaxone and vancomycin for 10 days with disappearance of clinical and analytical parameters of sepsis although with persistence of daily fever of 38o in the evening, well tolerated, with no other infectious focality in the complementary tests which included: serial blood cultures, urine culture, chest X-ray, abdominal ultrasound and cranial CT scan.
He was admitted to the internal medicine ward to complete the study and evolution; he remained haemodynamically stable and in good general condition, fever of up to 38.5oC well tolerated, right subclavian central venous access with no evidence of infection, few petechiae in the lower limbs in a phase of regression, with the rest of the general and neurological examination being normal.
The haemogram, haemostasis, renal, hepatic, thyroid and lipid profile were normal, with a ferritin value of 775 µg/dl, ESR 90 mm1 per hour, CRP at 23.8 mg/dl (VN <0.3 mg/dl) and procalcitonin at 0.22 ng/ml. Serology for hepatitis B and C virus, HIV, EBV, CMV, HSV types 1 and 2, Coxiella burnetti and Rickettsiae was negative; autoimmunity with ANA, ANCA, rheumatoid factor, immunoglobulins and complement were normal or negative. Mantoux reaction was negative; blood cultures via central catheter, peripheral blood and urine cultures were repeatedly negative; control cerebrospinal fluid was normal except for proteinuria of 65 mg/dl with negative smear microscopy and culture. Fundus examination, electrocardiogram, echocardiography and thoraco-abdominal CT with contrast were also normal.
A cranial MRI with contrast was requested, showing a discrete generalised meningeal uptake and multiple lesions between 7-10 mm, hypointense in T1 and hyperintense in T2 and Flair, in the temporal white matter, in the left external capsule, right periventricular, frontal and bilateral anterior parietal with marked peripheral uptake of contrast in a ring and associated perilesional oedema. Given the findings compatible with multiple brain abscesses secondary to meningococcaemia, an extensive literature search was performed (clinical practice guidelines, systematic reviews, bibliographic databases, meta-search engines and related non-indexed journals) which confirmed the scarce data reported regarding this complication. At this point it was decided to perform a PET-CT scan in order to rule out other possible findings/foci that could justify the persistence of the fever, which corroborated the hypermetabolic uptake of the brain lesions described, and the absence of uptake at other body levels.

Ruling out another infectious/inflammatory focus, treatment with parenteral ceftriaxone was maintained for 8 weeks, with slow but progressive disappearance of fever, gradual decrease until CRP and ESR normalised, as well as disappearance of brain abscesses in MRI control after finishing treatment, with no complications or recurrence of the condition in the subsequent outpatient follow-up.