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A 14-year old high school student with fever, chills and severe headache is seen in an urgent care clinic. At the clinic, his temperature is 104 °F, with neck rigidity and complains of back pain. Some small petechial spots are noted on his chest and back and in the mouth. Blood is drawn for a complete blood count and blood glucose, and a lumbar puncture is performed. Cerebrospinal fluid is collected sequentially in three sterile tubes and examined. The results are as follows:


Blood Results

White cell count: 25 ´ 109/L

Differential: 80% neutrophils, 10% lymphocytes, 10% monocytes

Glucose: 95 mg/dL

CSF Results

CSF pressure: Increased

Gross appearance: All tubes equally cloudy, not bloody

Glucose: 15 mg/dL

CSF white cell count: 12.0 ´ 109/L; 90% neutrophils

Gram stain: Many Gram-negative cocci in pairs, some intracellular

Critical Thinking Questions

1. Based on the Gram stain, what is the likely diagnosis for this patient? Explain the reason for your answer.




2. How can this patient’s diagnosis be differentiated from other similar clinical presentations?



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