Background: Temporomandibular joint (TMJ) arthritis is frequently seen in children with chronic arthritis. It has rarely been described in a non-infectious acute setting. We report a case of reactive arthritis isolated to the TMJs and cervical spine. Case presentation: A 6-year-old Native American boy hospitalized for treatment of lymphadenitis and aseptic meningitis had an incidental brain magnetic resonance imaging (MRI) finding of effusions in the TMJs, as well as the atlanto-occipital and C1-C2 articulations. Repeat TMJ and cervical spine MRI four weeks later showed resolution of effusions. Reactive TMJ arthritis has been previously reported in adults but not in children. Conclusion: This report represents the first pediatric case of reactive arthritis isolated to the cervical spine and TMJs. Arthritis of the TMJ should be considered in the differential diagnosis of children with reactive arthritides. © 2007 Arabshahi et al; licensee BioMed Central Ltd.