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EM@3AM: Meningococcal Disease

A 12-year-old girl presents to the ED with a 2-day history of headache and fever. The patient started vomiting with fevers this morning, and her mother was unable to wake her from her afternoon nap. She is lethargic and responds to painful stimuli with temperature of 38.2 C, blood pressure 88/65 mmHg, and HR 132 bpm. She has a petechial rash on her lower back and lower extremities, as well as resistance to neck flexion. What is the diagnosis?

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