Meningococcemia, caused by Neisseria meningitidis, is an important etiology of purpura, sepsis, septic shock, multiorgan failure and gangrene. A six-year-old girl admitted to emergency department with fever, somnolence and diffuse maculopapular rash progressing into ecchymotic lesions. Meningococcemia with septic shock was the initial diagnosis; aggressive fluid therapy and ceftriaxone was started. She had thrombocytopeniaassociated multiple failure, bleeding diathesis and hypotension. Therapeutic plasma exchange and continuous veno-venous hemofiltration was applied to the patient. Multiplex polymerase chain reaction of serum sample was positive for N. meningitidis serogroup W135. On the 9th day, the patient suffered from confusion. Cranial magnetic resonance imaging showed a lesion near to capsula interna suggesting early ischemia and an abscess. Brain abscess is rare during meningococcemia, in which septic emboli leading to ischemia could play a role in pathogenesis. The cerebral lesion may be due to an event common with septic and ecchymotic skin involvement.