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American Academy of Pediatrics
Index of Suspicion

Case 3: Two Preschoolers with Fever

Shraddha Mittal, Lauren Marlowe, Dustin Elliott, Deana Gifford, Kristen Ritenour and Howard Topol
Pediatrics in Review April 2019, 40 (4) 197-201; DOI: https://doi.org/10.1542/pir.2016-0202
Shraddha Mittal
*Children's Hospital of Philadelphia,
†CHOP Inpatient Pediatrics at Virtua, Voorhees, NJ
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Lauren Marlowe
*Children's Hospital of Philadelphia,
†CHOP Inpatient Pediatrics at Virtua, Voorhees, NJ
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Dustin Elliott
*Children's Hospital of Philadelphia,
†CHOP Inpatient Pediatrics at Virtua, Voorhees, NJ
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Deana Gifford
*Children's Hospital of Philadelphia,
†CHOP Inpatient Pediatrics at Virtua, Voorhees, NJ
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Kristen Ritenour
*Children's Hospital of Philadelphia,
†CHOP Inpatient Pediatrics at Virtua, Voorhees, NJ
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Howard Topol
*Children's Hospital of Philadelphia,
†CHOP Inpatient Pediatrics at Virtua, Voorhees, NJ
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  1. Shraddha Mittal, MD*,†
  2. Lauren Marlowe, MD*,†
  3. Dustin Elliott, MD*,†
  4. Deana Gifford, MD*,†
  5. Kristen Ritenour, MD*,†
  6. Howard Topol, MD*,†
  1. *Children's Hospital of Philadelphia,
  2. †CHOP Inpatient Pediatrics at Virtua, Voorhees, NJ
  • AUTHOR DISCLOSURE

    Drs Mittal, Marlowe, Elliott, Gifford, Ritenour, and Topol have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Case 1

A 15-month-old Boy with Fever, Refusal to Bear Weight, and Small Foot Lesions

Presentation

A 15-month-old boy presents to the emergency department in May with a 3-day history of fever, irritability, poor oral intake, and refusal to bear weight. He has no history of cough, vomiting, diarrhea, or rash other than a lesion on the sole of his left foot, where his mother reports there was a possible insect bite 1 week earlier. He was previously healthy, and his immunizations are up to date. He lives in a rural area of southern New Jersey. The family denies recent travel or ingestion of raw foods or milk. He had visited a farm 2 weeks earlier but denies direct contact with farm animals. He has had contact with a 2-year-old cat but denies bites or scratches.

On examination he is ill appearing. Vital signs reveal a temperature of 103.5°F (39.7°C) and tachycardia. He is irritable but does not have meningismus. His abdominal examination findings are normal. He has no appreciable lymphadenopathy. On extremity examination his strength is normal. He has two 2-mm, erythematous, raised, tender papules on the plantar aspect of his left foot, but otherwise no specific tenderness to palpation or swelling along his lower extremities. Due to fever and irritability, he underwent a full sepsis evaluation, including lumbar puncture, blood culture, and urine culture. Initial cerebrospinal fluid cell count was normal. His laboratory values are notable for a white blood cell (WBC) count of 15,700 × 103/μL (15.7 × 109/L), with 60% neutrophils, 31% lymphocytes, and 6% bands; C-reactive protein (CRP), 115 mg/L …

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Pediatrics in Review: 40 (4)
Pediatrics in Review
Vol. 40, Issue 4
1 Apr 2019
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Case 3: Two Preschoolers with Fever
Shraddha Mittal, Lauren Marlowe, Dustin Elliott, Deana Gifford, Kristen Ritenour, Howard Topol
Pediatrics in Review Apr 2019, 40 (4) 197-201; DOI: 10.1542/pir.2016-0202

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Case 3: Two Preschoolers with Fever
Shraddha Mittal, Lauren Marlowe, Dustin Elliott, Deana Gifford, Kristen Ritenour, Howard Topol
Pediatrics in Review Apr 2019, 40 (4) 197-201; DOI: 10.1542/pir.2016-0202
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