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QUESTION: Hi,

My 2 year old son has had an off an on fever for 1.5 months and constant HIGH fever for 16 days, ranging from 100-105, he's also has an awful cough for what seems like no reason. He's been hospitalized 3 times so far (for monitoring fever and lethargy) with no real results. He's had multiple chest x-rays and countless flu and strep tests and all come out clean. He's completed 2 rounds of augmetin and 1 round of omnicef and just started another 10 day go for omnicef. We went 2 days ago to have more blood tests and got some of the results back. His pedi said she was concerned about his WBC count but on the lab results it says it 10.5, which i thought was normal. His ESR is 58 and his CRP is elevated but i didn't get a value. He also had a TB skin test done on Wednesday and will go back tomorrow for them to check it out. He's also having another full work up and more blood tests and an ultrasound of his belly.His pedi mentioned him going to see an infectious disease specialist soon also. Is there anything else i should be doing? Questions i should be asking? I'm just trying to prepare myself so I'm not thrown a complete curve ball. There's so little information about this online.

Thank you for reading.

ANSWER: Hi, Nikki,

Sounds like your child is in good hands in terms of this evaluation of fever of unknown origin. (FUO).  I wonder what was supposed to be treated by the three rounds of a broad spectrum antibiotic.  What was the condition being treated?  Presumably it was not just given three times due to the fever alone?  Was there some source that was being treated?  I assume a urine has been checked and this is normal.  A peds ID consult would be the way I would go in this situation.  Please keep me posted and when the dx has been found, let me know.  Often these fevers in this situation are signs of some type of underlying autoimmune disease, like juvenile arthritis.

Good luck, Dr. Olson

---------- FOLLOW-UP ----------

QUESTION: I will most definitely keep you posted with what happens. I forgot to mention the first 2 times we were in the ER, he was misdiagnosed with pneumonia then on the 3rd visit, they said he didn't and they reviewed the previous two x-rays and apparently he never did. His pediatrician also confirmed that he doesn't and never did have pneumonia. He also had a mild ear infection. Which all of that is why he was on the antibiotics. Urine was also checked and it all came back normal. She did a pretty lengthy physical and checked his joints but said they all seem fine. I should get more results hopefully on monday. I have the earlier test results. ERS-58   CRP-12.8  MONO/100 WBC- 19.5 are the things that stuck out to her. The blood culture also had no growth. I'm just ready to find out whats going on. It's been a long couple of months.

ANSWER: Hi, Nikki,

A "mild" ear infection is a red herring here.  In no way does a questionable ear infection cause this extent of fever.  

The point of the juvenile rheumatoid arthritis is that the systemic presentation of this does not have joint pain or joint findings at all.  It is a serologic and clinical diagnosis, especially when other things are excluded.  The very high markers of inflammation, esp the CRP, would cause one to move in that direction.  

A good peds ID person will do the appropriate studies.  In some cases, a theraputic trial of aspirin can be helpful in sorting things out.

Good luck, Dr. Olson

---------- FOLLOW-UP ----------

QUESTION: Hi, again.

We saw the peds ID doctor on Thursday and he sent us to wolfsons children's hospital. This is our 3rd day here. They've ton tons of blood work, which all came and he didn't seem worried about it at all. He said the CRP abd ESR aren't that big of a deal...? He's also had a CT and it showed something going on with his spleen but then had another ultrasound that focused on his spleen and they didn't find anything with that. The doctor thinks it's just a FUO and says he's checked everything, but is keeping us here anyway. My son has been fine during the days then spikes fevers at night (102-104). He's also on IV ceftriaxone now. Is there anything I should ask? Anything you can think of that could also be checked? Being diagnosed as a FUO sucks and it can't be healthy for him to get such high fevers all the time.

Answer
Hi, Nikki,

Sounds like you are in a great place with skilled specialists looking over the entire situation.  Again, I kind of wonder about the numerous antibiotics.  Has anyone really suggested this is a bacterial illness?  If so, what is the source of the bacteria?  Anyway, this is the sort of referral I would do in this situation and hopefully they will come to some answer as to why this fever is persisting so long.  

Remember, he will not be hurt in the long term with any fever like this.  It's not "healthy" for him, but won't hurt him in any permanent way.

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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