A 7-year-old boy has a stiff neck and a purple non-blanching rash on the chest and arm, and discomfort with bright light. Which diagnosis is most likely?

• A. Kawasaki disease
• B. Measles
• C. Meningoencephalitis
• D. Meningitis

Answer: (D)

Stiff neck and sensitivity to bright light reflect irritation of the meninges, which points toward meningitis. The purple non-blanching rash indicates small-vessel bleeding in the skin, a classic sign of meningococcal infection and meningococcemia. Together, these signs in a child strongly suggest bacterial meningitis due to Neisseria meningitidis.

Kawasaki disease can cause fever and a rash but usually also involves conjunctivitis, strawberry tongue, and changes in the extremities rather than a purpuric rash or meningeal signs. Measles features a blanching, spreading maculopapular rash with fever and respiratory symptoms, not typically a stiff neck or photophobia. Meningoencephalitis involves brain inflammation but the presence of a non-blanching purpuric rash is most characteristic of meningococcal meningitis, which is a medical emergency requiring urgent assessment and treatment.