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Two-week old boy with fever lethargy and irritability
Case 9
You are moonlighting in the ER when a two-week old boy is brought in for fever, lethargy, and irritability.
He was the seven pound, two ounce product of a full term, uncomplicated pregnancy. Labor and delivery
were unremarkable, and his Apgars were 8 and 9 at one and five minutes. He had been well until this
morning when he developed irritability, lethargy, and poor feeding. He appears ill and is irritable and
inconsolable. He has a fever (38.5 C), a bulging fontanelle, supple neck and normal general
examination. Funduscopic examination is normal, as is neurologic examination except for generalized
hyperreflexia.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you treat this patient? How would you
monitor his condition and its treatment? What is the prognosis?(Assignment help)
Case 9.Two-week old boy with fever lethargy and irritability
You are moonlighting in the ER when a two-week old boy is brought in for fever, lethargy, and irritability.
He was the seven pound, two ounce product of a full term, uncomplicated pregnancy. Labor and delivery
were unremarkable, and his Apgars were 8 and 9 at one and five minutes. He had been well until this
morning when he developed irritability, lethargy, and poor feeding. He appears ill and is irritable and
inconsolable. He has a fever (38.5 C), a bulging fontanelle, supple neck and normal general
examination. Funduscopic examination is normal, as is neurologic examination except for generalized
hyperreflexia.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you treat this patient? How would you
monitor his condition and its treatment? What is the prognosis? Two-week old boy with fever lethargy and irritability.