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Updated 09 July 2015

What's your diagnosis? – Case 18: boy with persistent fever

A young boy has a persistent fever which does not react to pain medication. Have a look at the GP's notes and see if you can figure out what's wrong with him.

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Mrs K takes her 3 year old son to the GP complaining that the boy has had a persistent fever since the previous day. She tried giving him pain and fever medication, but his fever remains high.

The following is a summary of the GP's notes:

History:

One day history of persistent fever: often above 39.5

Mother reports upper respiratory tract symptoms since about a week ago, but the runny nose, slight cough and teary eyes have now cleared.

Continuous crying: escalated last night. 

Was constipated about two weeks ago

No medical history

Growing well

Feeding well

Immunizations up to date

On Examination:

Child warm to touch. Not jaundiced, pale, dehydrated 

Small lymphnodes in the neck

Cardiac and respiratory exam: normal

Abdominal exam: normal

Neurological exam: normal

Ears: red tympanic membrane left ear, right ear difficult to visualise eardrum because of wet wax discharge.

Nose: yellow muscus noted

Throat: significant post nasal drip. Tonsils slightly enlarged.

Side Room:

Temperature: 38.7 degrees Celcius

Based on the above information, what is the most likely diagnosis?

What's your diagnosis? Join the guesswork on our Facebook page, or comment below.

NOTE: Health24's on-site GP Dr Owen Wiese will reveal new cases on Thursdays. We'll post the answer with the story on Mondays, or you can get it via the Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis? -  Case 1: vomiting and weight loss

What's your diagnosis? -  Case 2: eye pain

What's your diagnosis? -  Case 3: strange behaviour and a bullet in the back

What's your diagnosis? -  Case 4: seeing odd things

What's your diagnosis? - Case 5: mysterious lungs

What's your diagnosis? - Case 6: runner with seizures

What's your diagnosis? - Case 7: swollen knee

What's your diagnosis? - Case 8: bloody semen

What's your diagnosis? - Case 9: confusing neurological signs

What's your diagnosis? - Case 10: diabetic teenager with unusual signs and symptoms

What's your diagnosis? - Case 11: bruising with no apparent reason

What's your diagnosis? - Case 12: severe tummy pain

What's your diagnosis? - Case 13: severe sore throat

What's your diagnosis? - Case 14: abdominal pain and swelling

What's your diagnosis? - Case 15: the world is spinning

What's your diagnosis? - Case 16: numbness in forearm

What's your diagnosis? - Case 17: burning urine

 
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