Meningococcemia. Necrosis and early gangrene in the toes and distal foot of a 14-month-old. The classic presentation of meningococcemia is the acute onset of fever in association with petechiae or purpura. Headache, myalgia, nausea, and vomiting may be present. Rapid progression to multiorgan failure can occur; complications include shock, acute respiratory distress syndrome, seizures, increased intracranial pressure, electrolyte abnormalities, renal failure, adrenal hemorrhage, anemia, thrombocytopenia, coagulopathy, pancreatitis, myocardial dysfunction, and compartment syndrome.