Case 2: Fever, Neck Pain, and Back Pain in a 16-year-old Boy

Emily Trauernicht; Sonum Bharill; Laura Panko; Erika Friehling

doi:10.1542/pir.2017-0156

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Emily Trauernicht, MD*
Sonum Bharill, MD^†
Laura Panko, MD^‡
Erika Friehling, MD^‡

^*Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
^†Wake Forest Baptist Health, Brenner Children’s Hospital, Winston Salem, NC
^‡Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA

AUTHOR DISCLOSURE
Drs Trauernicht, Bharill, Panko, and Friehling have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A previously healthy 16-year-old boy presents to the emergency department with 1 day of headache, neck pain, and fever. Three nights previously after soccer practice he had acute, severe low back pain, now resolved. He has otherwise been well, without nausea, vomiting, or vision changes. His immunizations are up to date. He has no known sick contacts. He does not take medications. He recently went camping but does not recall any insect bites.

Physical examination reveals an uncomfortable boy lying very still. His temperature is 100.9°F (38.3°C), heart rate is 91 beats/min, respiratory rate is 18 breaths/min, and blood pressure is 113/60 mm Hg. He has optic disc edema and limited range of motion of the neck with pain that radiates down his spine on flexion. The remainder of his physical examination findings are normal.

Laboratory evaluation reveals a normal complete blood cell count, basic metabolic panel, sedimentation rate, and urinalysis results. His C-reactive protein level is elevated at 3.85 mg/dL (38.5 mg/L). Findings from computed tomography of the head are normal. A lumbar puncture is obtained. Cerebrospinal fluid …