B****r
发帖数: 1737 | 1 看了三次医生，没有任何进展。可能下周要收入院了。小地方没有儿童医院，也不知道
该不该换个别的医生。恳请大家帮着瞧瞧 （病人情况如下）。万分感谢。
5 yo female with persistent cough x 14 days and fever x 10 days. Fever runs
102-104 F, but does normalize when given motrin or tylenol. Symptom no
improvement after 4 days of Azithromycin. Began to have loose stool /watery
diarrhea for past 3-4 days. She had complained of abdominal pain (mostly
peri-umbilical) intermittently for the past 2-3 weeks. Has a history of
problems with constipation. Slightly decreased PO intake, but still drinking
okay. Still playful when fever weans off by antipyretic. No headache/rash/
eye pain. No joint pain but sometimes complains lower extremities numbness
when she is sitting on the toilet.
No significant PMHx other than inguinal hernia. No significant FHx.
PE: 1+ tonsil without exudates, shotty cervical LN, vague abdominal pain,
otherwise no significant changes.
LAB:
1. CBC diff: Normal WBC, but left shift (no bands); no anemia
2. Elevated ESR (65) and CRP (48)
3. CMP: normal
4. UA: Trace blood, otherwise normal
5. Rapid strep/influenza A/B: negative
6. Rheumatoid factor: normal
7. Blood/nasal/stool culture: pending
8. RSV, CMV, EB virus: pending
IMAGING:
CXR: Bilateral peribronchial thickening, most likely 2/2 viral inflammatory
disease
Abdominal U/S: Normal limited visualization | B****r
发帖数: 1737 | 2 医生让继续吃退烧药，周一随访。我们每天吃最大剂量的退烧药，都好几天了，还是发
烧不断。真的一愁末展了。 | u****q
发帖数: 24345 | 3 Did the doctor rule out Kawasaki Disease? | r*****2
发帖数: 309 | 4 After 10 days, no need to treat Kawasaki dz since it won't cause any
difference. Btw: If the fever did response to antipyretics without other
criteria, the chance this child to have kawasaki dz is low. Most likely just
viral infection, treat symptomatically. | B****r
发帖数: 1737 | 5 Thanks a lot for your kind reply
They did consider incomplete kawasaki once....but she has no other symptoms
besides fever/cough/abdominal pain. Appendix abscess is not likely based on
normal u/s although the visualization is limited. They even did HIV test
which was negative.
No PPD has done yet, and CXR does not support it apparently.
I thought mostly likely viral infection, but persisting high fever really
worrisome. Plus, she frequently wakes up due to spiking fever or bad cough
in night, and she looks miserable when antipyretics weans off and fever
comes back
We will have a follow up appointment tomorrow...Docs has said the
possibility of admission to infections disease next week. I am hesitating to
put her in the hospital environment. | B****r
发帖数: 1737 | 6 Pending tests include RSV/CMV/EB virus, ANA, blood/stool/nasal culture...
Are there any other tests that might be helpful? I was thinking if she needs
an EKG or Echo (her lung is clear but she does have tachypenea).
Thanks again | s*****5
发帖数: 119 | 7 any hiking/camping history? any possible parasite exposure history?
Encourage the girl to spit the sputum, do not swallow it which sometimes
will make the abdominal pain worse.... | c*******u
发帖数: 1269 | |
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