Photo Rounds

Stiff neck

A 1-year-old boy in rural Haiti was brought to a multiple medical brigade with a high fever. The child had a temperature of 104°F and a stiff neck. The boy’s neck was so stiff that he could not flex it forward.

What's your diagnosis?


This was a classic presentation of bacterial meningitis.

When bacterial meningitis is suspected, a lumbar puncture should be performed and the cerebrospinal fluid analyzed for cells, protein, and glucose. A cerebrospinal Gram stain and culture should also be done.

Most cases of bacterial meningitis in children can be prevented by vaccines, although often times they are not available in developing countries. The most common causes of bacterial meningitis in children in areas where vaccines are not fully available include Streptococcus pneumoniae, Haemophilus influenza, and Neisseria meningitidis.

In this case, the child was given an intramuscular shot of ceftriaxone and transported to the local hospital for inpatient care. The medical team went to the hospital the next day to follow up on the progress of the child, but they were told that the mother had left the hospital with him prior to further evaluation and treatment.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Berggren R, Usatine R. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:53-79.

To learn more about the Color Atlas of Family Medicine, see:


You can get the second edition of the Color Atlas of Family Medicine as an app for mobile devices by clicking this link:


Next Article: