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

摘要

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.