A child with intermittent headaches and eosinophilic meningitis

Abstract

An 11-year-old previously healthy boy presented to the emergency department in March 2016 after 16 days of intermittent headaches associated with vomiting, 7 days of low-grade intermittent fevers, a wide-based gait, and weight loss. He was treated previously with diphenhydramine, promethazine, and ketorolac for headaches at 2 previous medical visits during this illness. Noncontrast magnetic resonance imaging (MRI) of the brain was performed on day 10 of illness, after his second presentation for medical care; the results were read as normal, and he was discharged home. He ultimately presented to our facility on day 16 of illness for further evaluation of his headaches and vomiting. The patient was born and raised in Colorado and lived with his parents and 3 siblings in the greater metropolitan Denver area. He had no significant previous medical history, and he had received all recommended immunizations. His overall growth was normal except for a recent 6-lb weight loss, which was attributed to vomiting. No history of a similar or unusual illness in his family or concurrent sick contacts was found. The patient and his family regularly traveled to Mexico to visit family on a farm that had goats and dogs. During these trips, the most recent of which had occurred 7 months before illness onset, he drank only bottled water, the only meat he consumed was chicken, and he did not consume any unpasteurized dairy product.