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.

II. PHYSICAL EXAM

Height, Weight
  • Height: 83 cm (75th percentile)
  • Weight: 10 kg (10th percentile)
Abdomen
  • Liver edge palpated 2 cm below RCM.
  • Soft and non-tender.
  • Bowel sounds are present.
  • Spleen tip is not palpated below the LCM.
Vitals
  • Temperature 36.8 (axillary)
    Normal range (36.0-36.9)
  • Heart rate: 152
    Normal range (80-130)
  • Resp. rate: 48
    Normal range (20-30)
  • BP 128/59
    Normal range (100-129/50-59)
Genitourinary
  • Normal male genitalia with both testicles descended.
HEENT (Tympanic membranes (TMs); sclerae, conjunctivae, pupils; nares; oropharynx)
  • Normocephalic
  • TMs within normal limits
  • Oropharynx within normal limits except for pale mucosal surfaces
Extremities
  • Normal in tone and passive ROM.
Neck
  • Shotty lymph node enlargement diffusely through both anterior cervical chains.
Neurologic
  • DTR's +2/4 bilaterally.
  • Cranial nerves II-XII appear grossly intact.
Chest
  • Lungs clear to auscultation and respirations are unlabored.
Heart
  • Regular in rhythm
  • Tachycardic
  • III/VI holosystolic murmur heard over left precordium
Skin
  • Pale, scattered red-purple spots ranging in size from 1-3 mm and non-blanching, located over legs, back, arms and trunk.

Have a question or comment about the ASH Teaching Cases? Please e-mail webmaster@hematology.org.