CASE:

The patient is an 8 year old male who presents to the emergency department with a chief complaint of a two day history of fever. His maximum temperature at home was noted to be 39.8 degrees C, axillary. He also has a slight cough but no coryza. A brief review of systems is unremarkable.

Examination in the ED:

VS: TEMP 38.7 degrees C, P 115, RR 20, BP 114/49, oxygen saturation in room air 97%. He is comfortable and is in no apparent distress. He appears non-toxic. HEENT unremarkable without signs of acute infection. Neck is supple without adenopathy, but his right sternocleidomastoid muscle is slightly tender. He has reproducible point tenderness over the thoracic spine, but he demonstrates full range of motion of the spine. Heart regular rhythm with no murmurs or extra heart sounds. Lungs are clear to auscultation. Abdomen soft, non-tender, no masses palpable, normal bowel sounds. No guarding. Non-distended. No hepatosplenomegaly. Normal male genitalia. His extremities are normal with good perfusion. His sensation and strength are good. DTRs are normal. What diagnoses are possible.

What laboratory studies or radiographs might be helpful at this point?
A CBC, blood culture and ESR are obtained. Because of the point tenderness over his thoracic spine, thoracic spine radiographs were ordered.
His WBC is 10.8 with 66% segs, 28% bands, Hgb 13,
Hct 49, platelets 220,000, ESR 3.

View his thoracic spine radiographs.

What is the diagnosis?

Last created on 01-07-2006