Figure 1

Quick Quiz

Which additional CSF finding is most likely?

An 11-month-old male with a two-day history of irritability and lethargy is brought to the emergency department by his mother. She reports that he has vomited four times today and has had fewer wet diapers than usual. He is up to date with his vaccinations. On examination, he is febrile, and a slight bulging of his anterior fontanel and neck stiffness are noted. Laboratory tests demonstrate a serum glucose of 75 mg/dL, and blood cultures and a lumbar puncture are performed. Analysis of the cerebrospinal fluid (CSF) reveals a predominance of neutrophils. Which additional CSF finding is most likely? Image credit: @IBercholcMD.

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