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A 2-year-old with 4 weeks of daily fever

John B Darby1, Lucette Liddell2, Marietta DeGuzman3

  • 1Section of Hospital Medicine, jbdarby@bcm.edu.

Pediatrics
|April 29, 2015
PubMed

Insights

A 2-year-old child presented with prolonged daily fevers and weight loss. Diagnostic considerations for fever of unknown origin (FUO) are discussed, including potential infectious etiologies.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Internal Medicine

Background:

  • A 2-year-old female developed persistent daily fevers (up to 40°C) lasting 4 weeks.
  • Initial symptoms included mild upper respiratory tract infection, which resolved, but fevers continued.

Observation:

  • The child experienced a 1-kg weight loss and appeared ill during fever episodes.
  • Physical examination revealed a thin, febrile child with tachycardia, tachypnea, and generalized lymphadenopathy.
  • Recent travel history from Saudi Arabia and a visit to a petting zoo were noted.

Findings:

  • Laboratory results showed an elevated white blood cell count (16,100 cells/uL) with neutrophilia.
  • Markedly elevated inflammatory markers: Erythrocyte Sedimentation Rate (ESR) at 99 mm/h and C-reactive protein (CRP) at 27 mg/dL.
  • Chest radiograph demonstrated small interlobar pleural effusions.

Implications:

  • This case highlights the diagnostic challenges of fever of unknown origin (FUO) in a pediatric patient.
  • Differential diagnoses for FUO in this context should consider infectious, inflammatory, and other systemic causes.
  • Prompt and comprehensive evaluation is crucial for identifying the underlying cause of prolonged fever and associated symptoms.

Keywords:
fever of unknown originhemophagocytic lymphohistiocytosismacrophage activation syndromesystemic juvenile idiopathic arthritistuberculosis

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