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Pediatrics/FUO and elevated ESR

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Question
Hello.  My 6 year old son has had a mild fever for 12 days straight. It peaked at about day 3 at 104, and has been coming down since - hovering right at 99-101 the last few days. His blood tests are mostly normal, however he does have an elevated ESR - 46. We retested today (2 days from the original test) and his ESR is now 51.  I don't have today's CBC results yet. He is not complaining of pain and really only has mild nasal congestion at this point. He is extremely tired and slightly irritable as well.  Mild appetite at best.  I would be curious to know your thoughts and also what we should do next. He has not been prescribed antibiotics during any of this.

Answer
Hi, Sarah,

Prescribing antibiotics is the hardest thing NOT to do in the pediatric world.  If there is no obvious source of the fever and the inflammation continues, then a further tier of tests should be done.  These may include a chest xray, a urine (probably all ready done), repeated careful exams.  The differential diagnosis is vast, including viral, parasite, bacteria, tumor, autoimmune disease and other illnesses like Kawasaki disease.

Be sure you have a good pediatrician and perhaps a peds ID person running the show.

Good luck, Dr. Olson

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David Olson, MD

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I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

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