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Suggest Treatment For Vomiting And Fever In A Teenager

Posted on Thu, 20 Apr 2017

Question: My nephew is 15 yrs old with a history of a stroke at less than a year old. He has limited use of his left arm and cannot stand or walk. He has had an illness for the past 3 weeks with symptoms of daily to multiple times a day vomiting and low grade fever during the day and higher temps at night - temps ranging from 100.5 to 103.5. He also has had sinus infection and a persistent cough which was treated with 2 rounds of antibiotics (amoxicillin and z pak). Chest X-ray results today are normal. Lab work just shows high white blood cells. Cultures are pending. He was started on a third antibiotic today- augmentin. His activity has not decreased much except when his temperature rises. What could possibly be a diagnosis for this prolonged illness?

Answered by Dr. Ishu Bishnoi (1 hour later)

Brief Answer:
Probable diagnosis of chronic cough

Detailed Answer:
Hi XXXX, thanks for asking from HCM.

I can understand your concern. The chronic cough, fever, high white blood cell count, weakness can be due to chronic illness. The possible differential diagnosis can be

- Autoimmune disorder like Wegner Granulomatosis, Sarcoidosis, lupus.

- Chronic viral infection like EB virus, HIV infection

- Chronic bacterial infection like Mycobacterium tuberculosis

- Chronic fungal infection like Histoplasmosis

To rule out these, he needs few specific investigations like

- ESR and CRP level
- Blood culture
- Sputum culture
- If all negative, bronchoscopy and aspiration of mucus for culture
- Peripheral smear
- HRCT of lung to detect missed lesions on X ray chest

Hope it will help. You can message me the reports of his investigations. I can help you in reaching some conclusion.
Thanks. Take care. Any doubt, do let me know.

Above answer was peer-reviewed by : Dr. Remy Koshy