A 5-year-old with fever, headache, neck stiffness, and leg pain

A 5-year-old boy presented with fever, headache, fatigue, neck stiffness, and 2 episodes of nocturnal urinary incontinence, prompting a visit to the emergency department. He had experienced intermittent frontal headaches and leg and buttock pain for several months, which had worsened over the previous 2 weeks. His history was notable for a spinal hemangioma with vascular tract, but he was otherwise healthy. On examination, he was febrile and tachycardic. He held his neck slightly rotated to the right with limited range of motion in all directions due to pain. No focal neurologic deficits were noted, and sensation and deep tendon reflexes were intact bilaterally. He was able to bear weight on both legs. There was no spinal tenderness or limitation in range of motion of his back and hips. There were no cutaneous manifestations, including no sacral dimple. A complete blood count with differential revealed leukocytosis of 31.98 × 103/μL (78.6% neutrophils, 16% bands). C-reactive protein was elevated at 2.4 mg/dL (0-1 mg/dL), and serum electrolytes, liver function tests, uric acid, and lactate dehydrogenase were within normal limits for age. Blood cultures were obtained before admission. Here we present his case, diagnostic evaluation, ultimate diagnosis, and complications.