Pediatrics/Re - occurring fever
QUESTION: I have a 21 month old that has been sick now for about 7 weeks - first 3 weeks - kept being told it was viral. Then he suddenly spiked a fever (104) and I couldn't get it to come down - trip to ER showed ear, throat, and chest infection. He was started on Cephalexin - 5 days later he spikes a fever again - take him back to family Dr. Who finds his ears and throat to look fine - but chest still "noisey" - changes med to Suprax (Cefixime) - he is on this on for 3 days and is again waking cry and grabbing at tummy - take in to dr - abdomen x-ray - says no constipation. next day is grabbing at ears and had fever again - see Dr ears and throat look fine - run urine test - check white blood count - everything comes back fine. next day spikes a fever - I treat fever - Monday - spikes fever - see Ear, Nose, Throat Specialist - no infection that he can see. next day fever - see dr and sent to hospital to see a pediatrician. Told that the crackle in his chest is him just needing to clear throat - fever is viral - and not eating and tired because his iron is probably low - orders CBC and fe test. next day spikes fever - go to family dr for results of test. CRP came back at 128 and iron is fine. He is admitted and put on IV antibiotics - for 36 hrs - then sent home with Cefprozil. Throat and Nose swabs came back fine - and some of the white blood cell markers came back high.
1. CRP is still at 75 - is this still a concern in your opinion
2. I was given antibiotics but told that they think it is viral I though viruses don't need drugs?
He wasn't eating - fever was predictable at 16:30 every day - he seems to be better again - but for how long this time I don't know - I am still worried my gut says that something is still being missed - and I would appreciate your opinion on this. Thanks
ANSWER: Hi, Sam,
He needs to see a good, consistent doctor, preferably a good pediatrician or a good peds infectious disease doctor to coordinate a good evaluation and treatment plan. Trips to the ER, ENT, family doc, and all over the place just don't make sense. Why was he put on the IV antibiotics? Using a "shotgun" approach doesn't make sense, from where I am. If the CRP is really 75, a number I am not accustomed to seeing (could it be 7.5?, even that is very high), then I would think along the lines of some sort of connective tissue/autoimmune disease, like juvenile rheumatoid arthritis. Your child needs to see some sort of specialist as I indicated above, preferably someone with access to or working for a pediatric hospital.
One virus does not last 7 weeks.
Good luck, D.r Olson
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QUESTION: We are usually consistent - I went to ER when Family Dr wasn't available but did follow up - he sent me to the hospital the two times that I saw a pediatrician. The IV antibiotics was because they had no idea what was going on so "just in case". On the copy of the blood work I requested it says CRP 75 H norm is 0-10 mg/L - so it is in metric - not sure how to convert it. And I will look in to the specialist you stated and supposedly it was one virus after another not the same one for 7 weeks. Thanks again
We do see repeated viral illnesses in kids this age, that can appear to be one illness. I carefully explore this by finding out historically if the child has days when he is fine and then gets sick again. The CRP is quite high, regardless of how this is determined and again, if this is one illness, my thoughts apply.
Good luck, Dr. Olson