Abstract

Background: Meningococcal infection is a rapidly progressive systemic infection that may lead to septic shock, multiorgan failure, and death within a short period. Early manifestations are often nonspecific, making early diagnosis challenging. In forensic practice, rapid deaths in young individuals should be evaluated through a combination of forensic autopsy, histopathology, and microbiological-molecular testing. Case Presentation: We report the case of a 19-year-old previously healthy male soldier who presented with sudden high fever of 39 - 40°C, fatigue, and rapidly spreading purpuric rash. The patient rapidly progressed to septic shock, cardiopulmonary arrest, and death approximately 12 hours after the onset of the first symptoms despite intensive resuscitation. Because of the rapid death in a young individual and the initially unclear cause, a forensic examination was requested by the competent authority. A forensic autopsy was performed at Military Hospital 175 by the Ho Chi Minh City Forensic Center approximately 4 hours after death, under case file number 229/2025/KLGĐTT-PY. Toxicological screening of blood was negative; postmortem cerebrospinal fluid real-time PCR was positive for Neisseria meningitidis. Autopsy and histopathological examination revealed purulent meningitis, cerebral edema, cutaneous hemorrhagic necrotic rash with dermal microthrombi, acute pulmonary edema with hemorrhage and microthrombi in small pulmonary vessels, coagulative necrosis and contraction band necrosis of myocardial fibers, acute tubular necrosis, scattered hepatocellular necrosis with mild inflammatory infiltration, diffuse bilateral adrenal hemorrhage consistent with Waterhouse-Friderichsen syndrome, and visceral congestion. Conclusion: This case demonstrates that meningococcal infection may cause very rapid death in young individuals with multiorgan injury. The integration of death circumstances, forensic autopsy findings, histopathology, and postmortem cerebrospinal fluid real-time PCR is important for identifying the etiologic agent and supporting the determination of the cause of death in hyperacute infectious deaths.