Question of the Week

Question :
Posted On : 10 Jul 2016
7 yr old male well built baby brought with c-o fever on nd off in nature since last 8 days,fever ranging betn 100-101 f on examination hr-88 bp:88, 50,cervical,axillary,inguinal lymphadenopathy,cvs nd rs NAD,per abd:no hepato spleenomegaly,cns normal. lab:hb:11,wbc:7200,plt:234000,esr:12,tt: neg,cxr:wnl,urine:wnl,widal:neg,was given tab.chloromycetin,lariago,pacimol,still getting spikes,what can be done_?
Expert Answer :
We need to know more about the past medical history , contact history , family history. The fever is low grade and the lab results so far are reassuring so I would not be too worried about this child at the moment. With the generalised lymphadenopathy, I`d be thinking about EBV or CMV infection. Obviously HIV is in the differential diagnosis. Has there been any rash_? oedema of the hands and feet_? red, cracked lips_? conjunctivitis_? - the child is a bit old, but we always need to consider Kawasaki Disease. Is there an eosinophilia_? - thinking about parasitic infection. Stool samples might be worth sending. No heart murmur_? - SBE should be considered. Were blood cultures taken before antibiotics_? If the fever persists, inflammatory disorders will need to be investigated - sJIA, lupus, etc - but in the absence of any joint symptoms , signs or rash, this would be lower on my list of possibilities.

I’d be very interested in the follow-up.

With best wishes

Gareth Tudor-Williams
Reader {Associate Professor} in Paediatric Infectious Diseases
Section of Paediatrics, Division of Infectious Diseases
Department of Medicine
Imperial College London, UK.
St. Mary`s Campus, London
Answer Discussion :
No answer discussion available.

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