This report describes the case of a 58-year-old female patient with a history of hypertension, dyslipidemia, and childhood asthma, who presented with neck stiffness, headache, and mild fever, raising concern for meningitis. Despite her high BMI and reluctance to undergo a lumbar puncture, she was initially treated with intravenous aciclovir and ceftriaxone while microbiological tests, including procalcitonin, ruled out bacterial infection. Laboratory markers, such as CRP and white blood cell count, improved over time, and cervical spine X-rays revealed cervical spondylosis with C4-C5 protrusion, explaining her symptoms. As a result, antimicrobial therapy was discontinued, and she was referred to a local spine specialist. This case underscores the need to consider cervical spine pathology as a differential diagnosis in patients with meningitis-like symptoms, particularly when invasive investigations are not feasible.
Nidhi Kakkar (Wed,) studied this question.