Grand Rounds

An Infant with Fever, Raised Inflammatory Makers and No Apparent Focus for Fever


Kollannoor B, Roberts M, Abdelaziz M
Department of Pediatrics, St Helens and Knowsley NHS Teaching Hospitals.

Address for Correspondence: Dr Maysara Abdelaziz, Consultant Paediatrician, St Helens & Knowsley NHS trust, Warrington Road, Prescot, Liverpool L35 5DR, UK. Email: Maysara.Aziz@sthk.nhs.uk


Clinical Problem:
A 4 month old male infant presented with fever for 4 days. He had no localizing signs on examination. He was irritable and suspected to have meningitis. Investigations showed white blood cells 28,100/cumm (neutrophils 21,500/cumm), platelets 554000/cumm and CRP 312mg/dl. Chest X-ray was normal and urine showed 25 pus cells/hpf but urine culture did not grow any organism. Cerebrospinal fluid (CSF) showed 8 cells/cumm, 1 red blood cell. CSF cultures were negative. Abdominal ultrasound (USG) and CT brain was normal. He was treated with intravenous antibiotics cefotaxime, amoxicillin and acyclovir. After 2 days of admission, he had a swollen ankle and slightly red lips. X-ray of the ankle was normal. Radioisotope bone scan showed no osteomyelitis. CRP was 212 mg/dl after 7 days of antibiotic treatment. Echocardiogram was done on day 8 which was normal. He remained irritable throughout this period.

What is the diagnosis?


Previous Grand Rounds View All

T
Tuberculous Pleural Effusion- Residual Pleural Thickening
Lavina Desai*, Ira Shah**
A 7 year old girl presented with fever for one month. Father had been treated for pulmonary tuberculosis (TB) 6 months ago. She was detected to have right sided pleural effusion with pneumonia on ches....
M
Musculoskeletal Cysticercosis
Lavina Desai*, Ira Shah**
A 23 year old female was referred to us in April 2016 with right shoulder swelling for 3 months. In January 2015 she had fever and right axillary lymphadenopathy and was diagnosed to have right forear....
P
Persistent Pseudomonas Aeruginosa Infection in a child with Cystic Fibrosis – How to manage?
Lavina Desai*, Ira Shah**
A 6 month old girl was diagnosed to have cystic fibrosis (CF) in 2009 in view of recurrent respiratory tract infections and diarrhea with malnutrition. Sweat chloride conductivity test was positive (7....
I
Is it Gaucher’s Disease or Niemann-Pick’s disease?
Lavina Desai*, Ira Shah**
A three and a half-year-old girl, currently bedridden, presented in 2013 with progressive loss of milestones from two years of age. On examination she showed poor oral hygiene, oral thrush over the ha....
R
Right Lung Opacification – What is the diagnosis?
Ilechukwu GC, Kollannoor B, Abdulaziz M.
A previously well, 7 week old baby presented to the paediatrics accident and emergency unit with a history of cough and fast breathing of one week duration associated with reduced oral intake of <50%.....
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.