UMEM Educational Pearls

Category: Pediatrics

Title: Fever and neck pain (submitted by Connor Lundy, MD)

Keywords: meningitis, neck pain, retropharyngeal abscess (PubMed Search)

Posted: 11/16/2012 by Mimi Lu, MD
Click here to contact Mimi Lu, MD


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?


Lateral neck x-ray

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.

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