The cause of a stiff and painful neck in a child is often elusive. Two cases of neck pain and stiffness associated with nonpalpable deep cervical adenopathy provide insight into situations where the cause of neck symptoms is uncertain.
Patient 1. A 16-month-old child presented with high-spiking fever lasting 2 weeks, neck pain and stiffness, and an evanescent rash consistent with systemic juvenile rheumatoid arthritis (Still disease). Imaging of the cervical spine by computed tomographic scan and magnetic resonance imaging showed multiple hypertrophied cervical lymph nodes. These were deep cervical nodes that were not palpable on physical examination.Patient 2. A 5-year-old child with Kawasaki disease presented with neck pain and stiffness. A computed tomographic scan of the cervical spine showed multiple hypertrophied cervical and submandibular lymph nodes. Again, this patient had no significant palpable cervical adenopathy, and no bony or soft-tissue abnormality was present on the scan.