Purulent meningitis in children can be both primary and secondary. The latter are the result of various surgical interventions, ENT pathology, immunosuppressive therapy, as well as craniocerebral and spinal trauma, which justifies the need for an integrated approach to differential diagnosis to select the appropriate therapy tactics. The article presents a clinical observation of a child in whom purulent meningitis developed on the background of epiduritis, which was the result of a spinal injury. The diagnostic search algorithm is described. The authors concluded that if the patient has laboratory confirmed purulent meningitis and adequate therapy with clinical improvement in the patient’s condition, but persistent febrile fever, an increase in inflammatory changes in the blood amid a decrease in the level of acute phase inflammation proteins (C-reactive protein) and negative procalcitonin the test requires a search for a local inflammatory focus using additional examination methods, such as MRI or CT, as well as consultations with a neurosurgeon That allows you to specify the diagnosis and to determine the conduct of tactics, thus providing a favorable outcome.