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Fever, Belly Pain, Confusion in a 9 year old Girl

A 9 year old girl was seen at an Emergency Room (ER) because she was agitated and confused. Four days before, she had fever, sore throat, and belly pain. A few hours before the ER visit, she vomited several times, talking inappropriately, and agitated. She had no headache, convulsion, cough, diarrhea, urinary symptoms, joint pains, rashes, injury, drug overdose, fear of light, recent travel, or contact with ill individuals.

The Physical examination at the ER showed a sick or toxic looking child, who is combative and agitated. She a fever of 104 F (39.6 C), heart rate of 150, and respiration of 40. Her blood pressure was 84/42. Her lips were dry and her extremities cold. Her pupils are equal in size and shape a reactive to light. There was no sign of increased pressure in the head or infection of the brain. Her reflexes were normal. There was slight redness of the throat. The rest of the physical examination were all normal.

Her blood count showed a hemoglobin of 12.7 g/dl, white blood cell count of 3800, platelet of 249,000. blood sugar of 132 mg/dl. Other blood tests were within normal limits. Spinal tap or lumbar puncture and abdominal X rays were both normal.

She was admitted in the hospital and was given intravenous fluid, oxygen, and antibiotic ceftriaxone.

Additional diagnostic test revealed her problem.

Click here for the diagnosis and discussion.

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