Pediatrics

12 year old boy presenting with fever

Amrit Misra on May 23, 2013

A twelve-year-old boy with a history of Hodgkin’s lymphoma presents to the ED with fever. This morning, his mother had noticed that he felt warm, and found that he had an axillary temperature to 102.  The patient and his mother notes that he has had severe nausea and vomiting following his recent cycle of chemotherapy, completed approximately two weeks ago, but otherwise has been in good health, with no cough, dysuria, shortness-of-breath, chest pain, abdominal pain, new rashes, or diarrhea.

Past medical history is significant for Hodgkin’s lymphoma, diagnosed six months ago.

Past surgical history is significant for a Mediport placement for his chemotherapy.

Medications include Bactrim for PCP prophylaxis.  He has no know drug allergies.

  • Temp  39 C
  • HR  110
  • BP  100/70
  • RR  20
  • O2  95% on Room Air

Physical Exam

General: 12-year-old boy, laying in bed in no acute distress.

Respiratory:  Clear bilaterally to auscultation.  No wheezes, crackles, or rhonchi.

Cardiovascular:  Tachycardic, with s1/s2 audible.  No murmurs, rubs, or gallops.

Abdominal: Soft, non-distended, nontender.  No rebound tenderness or guarding.  Bowel sounds audible.

Extremities: Warm, well perfused.  No cyanosis, clubbing or edema.

Skin: Port site is non-indurated, non-erythematous, and non-tender.  No rashes or other lesions visible.

Imaging:

CXR:  Decreased interval size of mediastinal mass (present on previous CXRs); otherwise within normal limits with no opacities visible in the lung fields.

BMP
136
4
106
10
0.6
28
78
CBC
0.4
10
75

A twelve-year-old boy with a history of Hodgkin’s lymphoma presents to the ED with fever. This morning, his mother had noticed that he felt warm, and found that he had an axillary temperature to 102.  The patient and his mother notes that he has had severe nausea and vomiting following his recent cycle of chemotherapy, completed approximately two weeks ago, but otherwise has been in good health, with no cough, dysuria, shortness-of-breath, chest pain, abdominal pain, new rashes, or diarrhea.

Past medical history is significant for Hodgkin’s lymphoma, diagnosed six months ago.

Past surgical history is significant for a Mediport placement for his chemotherapy.

Medications include Bactrim for PCP prophylaxis.  He has no know drug allergies.

  • Temp  39 C
  • HR  110
  • BP  100/70
  • RR  20
  • O2  95% on Room Air

Physical Exam

General: 12-year-old boy, laying in bed in no acute distress.

Respiratory:  Clear bilaterally to auscultation.  No wheezes, crackles, or rhonchi.

Cardiovascular:  Tachycardic, with s1/s2 audible.  No murmurs, rubs, or gallops.

Abdominal: Soft, non-distended, nontender.  No rebound tenderness or guarding.  Bowel sounds audible.

Extremities: Warm, well perfused.  No cyanosis, clubbing or edema.

Skin: Port site is non-indurated, non-erythematous, and non-tender.  No rashes or other lesions visible.

Imaging:

CXR:  Decreased interval size of mediastinal mass (present on previous CXRs); otherwise within normal limits with no opacities visible in the lung fields.

BMP
136
4
106
10
0.6
28
78
CBC
0.4
10
75

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