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<article xlink="http://www.w3.org/1999/xlink" dtd-version="1.0" article-type="obstetrics-and-gynaecology" lang="en">
  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher">JOHS</journal-id>
      <journal-id journal-id-type="nlm-ta">Journ of Health Scien</journal-id>
      <journal-title-group>
        <journal-title>Journal of HealthCare Sciences</journal-title>
        <abbrev-journal-title abbrev-type="pubmed">Journ of Health Scien</abbrev-journal-title>
      </journal-title-group>
      <issn pub-type="ppub">2231-2196</issn>
      <issn pub-type="opub">0975-5241</issn>
      <publisher>
        <publisher-name>Radiance Research Academy</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">526</article-id>
      <article-id pub-id-type="doi">http://dx.doi.org/10.52533/JOHS.2026.60502</article-id>
      <article-id pub-id-type="doi-url"/>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Obstetrics &amp; Gynaecology</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Fulminant Meningococcal Meningitis in a Pregnant Woman with AQP4-Positive Neuromyelitis Optica Receiving Ravulizumab: A Case Report&#13;
</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Almheiri</surname>
            <given-names>Shaikha</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Musa</surname>
            <given-names>Asma</given-names>
          </name>
        </contrib>
      </contrib-group>
      <pub-date pub-type="ppub">
        <day>31</day>
        <month>05</month>
        <year>2026</year>
      </pub-date>
      <volume>6</volume>
      <issue>5</issue>
      <fpage>269</fpage>
      <lpage>277</lpage>
      <permissions>
        <copyright-statement>This article is copyright of Popeye Publishing, 2009</copyright-statement>
        <copyright-year>2009</copyright-year>
        <license license-type="open-access" href="http://creativecommons.org/licenses/by/4.0/">
          <license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence, and indicate if changes were made.</license-p>
        </license>
      </permissions>
      <abstract>
        <p>Background: Neuromyelitis optica spectrum disorder (NMOSD) is a recurring autoimmune disease of the central nervous system. Disease management is particularly challenging during pregnancy, as 77% of patients have experienced relapses during the intrapartum and postpartum period. This can be attributed to immunomodulation during pregnancy, which leads to increased disease activity. The pathogenesis involves Aquaporin 4 (AQP4) IgG antibodies binding to astrocytic water channels, initiating complement activation, resulting in astrocyte injury. Complement inhibitors are increasingly used to prevent relapses. Nevertheless, terminal complement blockade is associated with high susceptibility to infections by encapsulated bacteria, particularly Neisseria meningitidis.&#13;
&#13;
Case presentation: We report a case of a 32-year-old pregnant woman at 33+4 weeks’ gestation, who presented to the emergency department with acute fever and confusion. She had a known history of AQP4-IgG-positive NMOSD and received 300 mg ravulizumab every 8 weeks. Blood and cerebrospinal fluid analysis indicated systemic infection. Gram staining revealed Gram-negative diplococci; polymerase chain reaction (PCR) confirmed Neisseria meningitidis infection. Complementary studies revealed complete inhibition of terminal complement. She&#13;
&#13;
Conclusion: This rare case demonstrates the therapeutic dilemma in managing NMOSD during pregnancy. While continuing treatment carries the risk of infection, stopping the drug could potentially lead to a relapse. Further studies are essential to establish safety and clinical guidelines for the management of such autoimmune diseases during pregnancy.&#13;
</p>
      </abstract>
      <kwd-group>
        <kwd>Fulminant Meningococcal Meningitis</kwd>
        <kwd> Maternal Health</kwd>
        <kwd> Neuromyelitis optica spectrum disorder</kwd>
        <kwd> Pregnancy</kwd>
        <kwd> Neuroimmunology</kwd>
        <kwd> Neisseria meningitidis  </kwd>
      </kwd-group>
    </article-meta>
  </front>
</article>