Meningococcemia is a rare but devastating disease that affects primarily the pediatric population. The virulence of Neisseria meningitidis is 100 times that of other gram-negative organisms, making prompt recognition and treatment essential to prevent significant morbidity and mortality. Management of these patients in the pediatric intensive care unit is a challenge and requires skilled clinicians, high level technology, and novel therapies. Research into more effective treatment for meningococcemia continues in hopes of improving mortality and decreasing morbidity associated with this disease; however, thus far, prompt recognition of the signs and symptoms and aggressive treatment remain the mainstay of survival.