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It was my first day on call as a paediatric registrar and nearly my last—I missed a case of meningococcal disease. A concerned looking doctor in the emergency department came to find me, and being new to the hospital I didn’t know she was the department’s consultant. She took me to see a toddler, saying, “This is the rash we see with meningococcal disease.” Emily, who was sitting on her mother’s lap, smiled at me. She had a fever of 40°C and a widespread blanching rash. I was full of the knowledge and confidence acquired by recently passing postgraduate exams. I knew meningococcal disease presented with a petechial rash and was unimpressed. At the emergency doctor’s insistence I admitted Emily. I did a lumbar puncture, which was entirely normal. I therefore gave her no treatment and observed her for 48 hours. Her fever settled, she remained well, and I sent her home.

The next day the laboratory phoned me to say that Emily’s blood culture was growing Neisseria meningitidis. I phoned her mother: “Hello, it’s Dr Riordan from the hospital. How is Emily?” “Oh she’s fine, doctor.” “Could you bring her back to the hospital, please.”

Emily was readmitted. Her repeat blood culture was sterile, but I gave her intravenous antibiotics for seven days, “just to be sure.”

My fascination with meningococcal disease began with Emily’s illness. How could she seem so well when other children could be critically ill in 12 hours? She sparked off a case report, research fellowship, thesis, BMJ paper, and career in paediatric infectious diseases. This allowed me to give advice to the Meningitis Research Foundation, the National Institute for Health and Care Excellence, and the Department of Health, culminating in helping to recommend meningococcal B vaccination for all UK children.

I learnt three valuable lessons from Emily. Firstly, meningococcal disease can present with a blanching rash. Secondly, meningococcal disease is not just meningitis. Lumbar puncture is normal in those with the more severe form of the disease—septicaemia. Thirdly, if an experienced doctor tells you the diagnosis, they are probably right.