Fever and Petechiae in an Infant

James Harper, MD

Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE

This case was reviewed and updated in May 2011 by members of the Teaching Cases Subcommittee

Copyright of the American Society of Hematology, 2006. ISSN: 1931-6860.

I. HISTORY

Patient Presentation

A 17-month-old male is admitted to the hospital with a two-week history of fever (T max 104ยบ F) and a two-day history of rash on his legs. Ten days ago, his primary care physician treated him with a 7 day course of Ceftin for a presumptive diagnosis of otitis media. Upon follow-up visit, it was found that he was still febrile and required ibuprofen nearly daily to control fevers. It was also found that he had lost weight, presumed to be due to decreased appetite.

What questions pertaining to the present illness are most relevant at this point?

Rash
Can you tell me where the rash started?
Does the rash blanch?
Has the rash changed in appearance since you first noticed it?
Has he been trying to scratch the rash?
Fever
Did the fever improve with the antibiotics?
Does the fever come on during particular times in the day?
Has he had antibiotics in the past?
Has he been in contact with other children or adults who are sick?
Weight Loss/Activity Level
When did you first notice that he had lost weight?
How much weight has he lost?
What kind of diet does he eat?
Have there been changes in his diet?
Have there been changes in his activity level?

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