Pneumococcal Meningitis in an Adolescent with Fever and Foot
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Clinical Case
A 12-year-old adolescent male presented to the Emergency Department, in January 2010, with a febrile illness. For the last 3 days, he had been complaining of dry cough, diffuse myalgia, frontal headache, and sporadic postprandial vomiting. Two days before admission he developed intermittent high fever (axillary temperature 40°C), cervicalgia, and a progressively worsening left midfoot ache. He denied any trauma history or previous limping or pain. His personal medical history was unremarkable and he had received all the vaccines included in the National Plan, which encloses meningococcal serogroup C and Haemophilus influenzae type b immunizations but not an antipneumococcal vaccine.

On physical examination, he was alert and oriented, with normal vital signs. He had an abnormal gait, avoiding left plantar pressure. The anterior surface of his left ankle was tender, swollen, and warm to touch. Clinical examination was otherwise unremarkable, including normal breath sounds and absence of meningeal signs. Laboratory evaluation revealed a mildly elevated leukocyte count (13,540/?L) with neutrophilia (11,860/?L), as well as elevated C-reactive protein (14?mg/dL) and erythrocyte sedimentation rate (55?mm/h). There were no abnormalities on thorax, left foot, and ankle radiographs.....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728537/
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