[Pubmed] Case Report: Fulminant meningococcus-meningitis under treatment with ravulizumab despite complete vaccination-a

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Front Med (Lausanne). 2026 Sep 23;13:1943514. doi: 10.3389/fmed.2026.1943514. eCollection 2026.

ABSTRACT

OBJECTIVES: Complement C5 inhibitors such as ravulizumab are increasingly used for acetylcholine receptor-positive 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.

METHODS: Case report.

RESULTS: A 41-year-old woman with acetylcholine receptor-positive 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 Neisseria meningitidis serotype Y. 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.

DISCUSSION: 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.

PMID:42845921 | PMC:PMC13642633 | DOI:10.3389/fmed.2026.1943514


Source: https://pubmed.ncbi.nlm.nih.gov/4284592 ... 9&v=2.20.1