The patient's clinical and radiological findings triggered ER physicians to perform a lumbar puncture and a blood culture, both of which were positive for Neisseria meningitidis; confirming the diagnosis of pyogenic meningitis.

In addition to the diffusely hypodense aspect of the spleen on the abdominal CT, the diagnosis of splenic infarction was further ascertained by the presence of multiple bright band signs ².

Splenic infarction following meningococcal infection can occur by two main mechanisms ¹: disseminated intravascular coagulation (DIC) and abscess formation. This patient had low platelet count, high d-dimer, and low fibrinogen; in keeping with DIC. Moreover, no enhancing peripheral splenic capsule was seen on the abdominal CT to suggest the presence of an abscess.

The patient evolved favorably after administration of IV ceftriaxone, receiving his hospital leave 6 days after admission. Prophylactic vaccination against encapsulated bacterias, as well as preventive splenectomy (due to the high risk of abscess formation), were scheduled.