A previously healthy 8-year-old boy has a 3-week history of low-grade fever of unknown source, fatig

Discussion in 'MRCPCH forum' started by samuel, Sep 13, 2014.

  1. samuel

    samuel New Member

    A previously healthy 8-year-old boy has a 3-week history of low-grade fever of unknown source, fatigue, weight loss, myalgia, and headaches. On repeated examinations during this time, he is found to have developed a heart murmur, petechiae, and mild splenomegaly. Which of the following is the most likely diagnosis?
    a. Rheumatic fever
    b. Kawasaki disease
    c. Scarlet fever
    d. Endocarditis
    e. Tuberculosis
  2. samuel

    samuel New Member

    The sne is D
    The presentation of
    infective endocarditis can be quite variable, ranging from prolonged fever with few other symptoms to an acute and severe course with early toxicity. A high index of suspicion is necessary to make the diagnosis quickly. Identification of the causative organism (frequently Streptococcussp. or Staphylococcussp.) through multiple blood cultures is imperative for appropriate treatment. Echocardiography may identify valvular vegetations and can be predictive of impending embolic events, but a negative echocardiogram does not rule out endocarditis. Treatment usually consists of 4 to 6 weeks of appropriate antimicrobial therapy. Bed rest should be instituted only for heart failure.
    Antimicrobial prophylaxis prior to and after dental cleaning is indicated.
    The child is older than typical for Kawasaki disease (80% will present under the age of 5 years), and the history is not consistent with the diagnosis. Scarlet fever is typically self-limited and would not be consistent with the 3-week time course. Tuberculosis can cause prolonged low-grade fever, but cardiac involvement is unusual, consisting of pericarditis; thus a friction rub would be the typical examination finding

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