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A 5-Year-Old With Fever, Headache, Neck Stiffness, and Leg Pain
Joy Solano1, Grace Winningham2, Duha Al Zubeidi3
1Divisions of General Pediatrics, and jlsolano@cmh.edu.
Insights
A child with a history of spinal hemangioma presented with concerning symptoms including fever and neck stiffness. This case highlights the diagnostic challenges and potential complications associated with spinal vascular malformations in pediatric patients.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Infectious Disease
Background:
- A 5-year-old boy with a known spinal hemangioma experienced worsening headaches, leg pain, and new-onset urinary incontinence.
- Symptoms progressed over weeks, leading to emergency department evaluation for fever, neck stiffness, and fatigue.
Observation:
- Physical examination revealed fever, tachycardia, and painful limitation of neck range of motion.
- Laboratory tests showed leukocytosis with neutrophilia and elevated C-reactive protein, suggesting an inflammatory or infectious process.
- Neurological examination was otherwise unremarkable, with intact sensation, reflexes, and motor function.
Findings:
- The case details the diagnostic journey, including investigations performed to identify the underlying cause of the patient's symptoms.
- The ultimate diagnosis and any complications arising from the condition are discussed.
- This presentation underscores the importance of considering complex etiologies in pediatric patients with seemingly common symptoms.
Implications:
- This case emphasizes the need for thorough evaluation of pediatric patients presenting with constitutional symptoms and neurological signs, especially those with pre-existing conditions.
- Understanding the potential complications associated with spinal hemangiomas is crucial for timely diagnosis and management.
- Further research into the relationship between spinal vascular malformations and associated neurological or infectious complications may improve patient outcomes.
Abstract:
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.
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