Differential Diagnosis
- Single most likely diagnosis
- Enterovirus meningitis: The presence of fever, cough, headache, and a spotty rash, followed by intensified headache, photophobia, vomiting, and positive symptoms of Kernig and Brudzinsky, are indicative of meningitis. The detection of IgM class antibodies to ECHO virus (a type of enterovirus) in ELISA strongly supports this diagnosis.
- Other Likely diagnoses
- Meningococcal meningitis: Although the rash described is not typical for meningococcal disease (which usually presents with a petechial or purpuric rash), the severe condition, headache, photophobia, and positive meningeal signs could suggest this diagnosis. However, the absence of a characteristic rash and the presence of ECHO virus antibodies make it less likely.
- Meningococcal meningoencephalitis: Similar to meningococcal meningitis, this diagnosis could be considered due to the severe presentation and meningeal signs, but the specific findings and laboratory results point more towards an enteroviral etiology.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Meningococcal meningitis and Meningococcal meningoencephalitis: Despite being less likely given the laboratory findings, these conditions are medical emergencies that can have a high mortality rate if not promptly treated. The presence of fever, severe headache, photophobia, and signs of meningeal irritation necessitate considering these diagnoses to ensure timely intervention if they were to be the actual cause.
- Rare diagnoses
- Toxoplasmosis: This infection can cause neurological symptoms, but it is less common in immunocompetent children and typically does not present with the acute onset of fever, cough, and rash as described.
- Echinococcosis of the brain: This parasitic infection is rare and would not typically present with the acute symptoms of meningitis or the specific laboratory findings of ECHO virus antibodies. It is an unlikely diagnosis given the clinical presentation and laboratory results.