Meningococcal meningitis is a rapidly progressive and potentially fatal illness of early infancy, often presenting acutely with diverse neurological complications. Caused by the gram-negative diplococcus Neisseria meningitidis, it typically manifests with fever, irritability, altered sensorium, and seizures. Despite advancements in antimicrobial therapy and neuroimaging, delayed diagnosis or treatment can lead to severe outcomes. While encephalitis and raised intracranial pressure are known sequelae of meningococcal infections, subdural empyema is an extremely rare but life-threatening complication, especially in the infant population.

We present the case of a three-month-old male who arrived with febrile status epilepticus and was later diagnosed with meningococcal meningoencephalitis complicated by subdural empyema. Notably, blood and cerebrospinal fluid cultures confirmed Neisseria meningitidis, aiding in definitive diagnosis. The infant’s neurological status continued to deteriorate despite antimicrobial therapy, prompting neuroimaging that revealed a subdural empyema. Surgical intervention alongside prolonged intravenous antibiotics resulted in gradual recovery.This case is particularly significant due to its uncommon presentation, the confirmed microbiological diagnosis, and the rare occurrence of subdural empyema in such a young patient.The nonspecific clinical features of this complication—often mimicking ongoing meningoencephalitis—can delay recognition, especially in infants. This report highlights the critical importance of maintaining high clinical suspicion for intracranial complications in infants with prolonged seizures or poor neurological recovery despite treatment. It underscores the necessity for prompt neuroimaging, multidisciplinary management, and aggressive therapy to optimize outcomes.