CASE PRESENTATION: A 25 year-old previously healthy male presented to the emergency room with one day of abdominal pain, nausea, fevers/chills, and pleuritic chest pain during a trip to Las Vegas with a “sick contact“. The patient was febrile and tachycardic with an otherwise normal physical exam. While in the ER, he became hypotensive to 63/43 despite 3 liters of normal saline. An electrocardiogram showed diffuse ST segment elevations. Initial labs were remarkable for a white blood cell count of 10.4 K/UL (92% neutrophils), lactic acid 1.8 mmol/L, and troponin <0.01. Echocardiogram showed an ejection fraction of 25% with diffuse hypokinesis. Chest radiograph was normal. He was started on norepinephrine, broad spectrum antibiotics and additional intravenous fluids with subsequent improvement in his blood pressure. While in the intensive care unit, his vasopressor requirement increased over the next 24 hours with lactate rising to 4.4 mmol/L and troponin to 75 ng/mL. By hospital day 2, his vasopressor requirements, lactate, and troponin decreased with additional fluids. Preliminary blood cultures were positive for gram negative diplococci, which speciated to Neisseria meningitidis. Lumbar puncture results were normal. Antibiotics were de-escalated to a 3rd generation cephalosporin. On HOD 4, the patient was weaned off the vasopressor and bedside echo showed improvement in his EF to 40%.