Level 1: Fever – Contrasting Case #1: Patient Information

Given these changes from the original case, what is your diagnosis?

What is your diagnostic explanation?

As compared to the long case, this patient, Carl, is a 5 year old boy with a one day history of fever. He has also had a runny nose for the past week. The family decided to go camping over the weekend and the weather was unseasonably warm. According to Mom, Carl played all morning with other children at the camp and wasn’t very hungry during lunch, then late in the afternoon, wandered back to camp and promptly laid down in his tent to sleep. Normally Carl is very active at 4 in the afternoon and always wants a mid-day snack and juice box. Mom says Carl was difficult to arouse and once awake complained of a headache and nausea. He didn’t throw up. Mom noticed his head felt warm and took his temperature which read 103.5. No history of recent URI’s, no previous history of ear infections, no cough/sore throat, no fatigue prior to this afternoon. Mom didn’t see him use the bathroom yet today but states he is potty trained and assumes Carl would have urinated in the woods.

PMH: Known history of seasonal allergies (specifically grasses and pollen). His mother gives him Benadryl to help with symptom relief. No other changes to the PMH or FMH mentioned in main case.

Physical Exam: Vital signs are HR 135, BP 95/65, RR 20, Ht 43” (109cm) 50%, Wt 40lbs (19kg) 50%, temperature 102.6 degrees Fahrenheit. No findings in the ear canal. Nasopharynx and oropharynx are non-erythematous/edematous. His skin/face is flushed and his skin feels clammy and dry, he is not sweating. Neurologic exam showed an unsteady gait and he falls asleep whenever not directly interacted with. His reaction times are decreased, no gross motor weakness, no tenderness/pain elicited with flexion of the neck. No papilledema or abnormality on fundoscopic exam, technically difficult due uncooperativeness.

Labs: CBC is WNL, CMP WNL. Rectal temperature shows elevated core temperature