A 1 year old gets sent from their pediatrician’s office for rule out meningitis. They presented with fever for 2 days and neck rigidity. Your LP results are normal. What additional test should you consider?
Answer:
Lateral neck x-ray
http://www.hawaii.edu/medicine/pediatrics/pemxray/v2c20.html
Retropharyngeal abscess (RPA) can commonly present like meningitis. Have a high suspicion in
children who are too young to complain of sore throat or difficulty swallowing.
A recent article in Pediatric Infectious Disease Journal detailed the rising incidence of retropharyngeal abscess, especially in younger patients, which is attributed to community acquired MRSA.
From 2004-2010 there was a 2.8 fold increase in RPA from the previous study period (1993-2003).
Children whose abscess grew MRSA were younger (mean 11 months) than the others (mean 62 months) (P < 0.001) and required longer duration of hospitalization (mean 8.8 days) than the rest (mean 4.5 days) (P = 0.002).
Bottom line: Consider a plain film in the child you are preparing to LP for meningitis.
Reference:
Abdel-Haq, N, Quezada M, Asmar BI. Retropharyngeal abscess in children: the rising incidence
of methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J 2012; 31: 696–699
