Clinical History.—A 6-year-old boy had been well until 24 hours prior to coming to the hospital. At that time he complained of a sore throat and had a nonproductive cough. He also had vomited several times but there was no diarrhea. There was no known exposure to infectious diseases.
In the past he had had several episodes of upper-respiratory tract infections, but otherwise he was healthy. The family history is noncontributory.
Physical Examination.—The patient was lethargic and his temperature was 39 C (102 F). The tympanic membranes were normal. The pharynx was injected and there was pain with flexion of the neck. The chest was clear to auscultation. No murmurs were heard and the heart rate was normal. The abdomen was soft but there was diffuse nonlocalized tenderness. Results of the neurological examination were normal, except for a questionable stiff neck.
Laboratory Studies.—The hemoglobin value was