Which sign is commonly associated with meningitis in a child?

• A. Rash on trunk with fever.
• B. Headache with neck stiffness only.
• C. Nuchal rigidity (stiff neck) with fever and altered mental status.
• D. Abdominal pain and diarrhea.

Answer: (C)

Meningitis causes irritation of the membranes around the brain and spinal cord, so a stiff neck (nuchal rigidity) is a classic physical sign of meningeal irritation. When this stiffness appears together with fever and altered mental status, it strongly points to central nervous system infection rather than a benign febrile illness. The combination reflects both systemic illness (fever) and specific CNS involvement (stiff neck and changes in consciousness), which is what you’d expect with meningitis.

Rash on the trunk with fever can occur in some meningitis cases, especially meningococcal disease, but a trunk rash by itself isn’t as specific or reliable for diagnosing meningitis. Abdominal pain and diarrhea are not typical signs of meningitis and usually point to GI conditions. In younger children, signs can be non-specific, but fever with neck stiffness and altered mental status remains the most characteristic signal of meningitis. Early recognition is crucial for prompt evaluation and treatment.