LAUSR

We report the case of a 9-year-old girl was admitted to the hospital with fever, headache, and vomiting. Physical examination revealed stiff neck, positive Brudzinski's sign, negative Kerning's sign, and skin rash in lumbar region. In her past medical history, there were no relevant data except for food allergies and atopic dermatitis but no immune deficiency was identified. Computed tomography scan of brain showed no acute findings and the blood test showed normal inflammatory markers: C-reactive protein 2.40 mg/dL [Reference value (RV) 1–10 mg/dL] and procalcitonin 0.05 ng/mL (RV <0.1 ng/mL). Clinical examination and laboratory testing of the blood sample raised suspicion of viral meningitis, so a lumbar puncture was performed to obtain a sample of cerebrospinal fluid (CSF). In the laboratory, CSF examination also revealed normal protein and glucose concentrations, but the cell count study showed lymphocytic pleocytosis with 480 white blood cells/μL: 60% lymphocytes, 16% monocytes, 22% basophils, and 2% eosinophils. However, abnormal findings were not evidenced in peripheral blood (Figure 1). Despite a negative Gram stain, bacterial culture of CSF was performed and a CSF and skin vesicles virus study was also requested.