My 11 month old son (born 7/9/11) has had periodic low grade fevers for >2 months. Almost every day his temperature reaches 100-101. And then he acts fussy with crying & wimpering and only wants to be held. This is often when he wakes from a nap or around 2-3am. I give him Acetaminophen or Ibuprofen to lower his temperature. He has had multiple blood & urine tests, but the cultures don't grow anything.History:- He has hydronephrosis, and he had a bilateral pyeloplasty at 4 months.- At 6 months, he was hospitalized for hyponatremia (< 112 mEq/L), and the Endocrinologist believed it was related to hyperaldosteronism. - He just had his second stent removed yesterday (no stents now), but he awoke last night with 100.8 temp and very fussy/crying/wimpering/hot all over. Any thoughts? Our Urologist has thought that the past few months of low fevers were not related to his ureter stent, but we were hoping that he was wrong. Thank you!
Person's Gender: Male
Age: 11 months
Blood CBC and Urine cultures.
Antibiotics: Keflex, Augmentin.
Both ureter stents have been removed.
Hello, IF the fevers were stent-related they may not subside for 48 hours after removal. Recommend blood and urine cultures be repeated, as well as renal ultrasound to look for possible abscess. CT scan may be needed in future but that involves a significant amount of radiation and sedation for your baby, so would start with ultrasound now.
Hello? Please reply when you're online!
I am very concerned about your child.
Hello, Thank you for your response!
His pediatrician would also like to re-run blood and urine cultures, so I expect we will do so. That is good to know that we should give it 48 hrs before we can assume that the fevers are not stent related.
His pediatrician agrees that something is wrong, we wanted to wait until stent removal to see if he would improve after that. He actually had a temp of 103.5 on 6/18, so was admitted to hospital. Gave him tylenol, and has not had another high temp since then -- has not been on an antibiotic.
I was hoping that you might have some ideas for what my pediatrician could look for, specific things to test for? While at UCSF hospital, my son saw Urology, Pediatrics, and Infectious Diseases, but they did not see anything wrong. Here's a recently timeline: ur family has all been healthy for the past 2 months, although (Note: until just this afternoon, my husband started feeling flu like symptoms.)
Sorry, I started to type this --> Here's a recent timeline: 4/25 - Left Stent was removed4/29 - Son diagnosed with urinary infection (after vomiting, shaking, fever) - Keflex 10 days5/16 - Son started acting fussy, felt pretty warm, but I didn't take temperature :( ... continued to be fussy & warm periodically everyday5/22 - Urine test (bagged) borderline results, culture grew 50-75k Enterococcus - Amox-Clav 10 days
5/23- 5/30 - periodic low fever 1x or 2x daily (up to 101F)5/31 - temp 102.5, admitted to hospital for 3 days, blood & urine cultures grew nothing, sent home with Keflex (took through 6/13)6/3-6/5 - NO fevers6/6-6/17 - periodic low fevers6/18 - 103.5, admitted to hospital for 2 days, blood & urine cultures grew nothing. No antibiotic... some days still has a slightly elevated temp (99.5-100) and gets fussy.6/28 - Stent removal (Right side)
[I realize this is a lot, and of course I do not expect you to figure out what is wrong. But please let me know any ideas for things that might not normally be checked that could be causing his fevers. I will be happy to have any new thoughts. Many thanks.]
Hello,With intermittent procedures and stents, Your son very likely has urinary sepsis related fever. Was he not given long term prophylaxis with say nitrofurantin? This drug may now be tried for fever if not settled 2 days after stent removal.Low sodium level also needs to be looked into because hyperaldosteronism gives rise to hypertension and HIGH sodium levels - Aldosterone helps control blood pressure by holding onto salt and losing potassium from the blood. How has his growth been so far? Any signs of either dehydration or puffy eyelids and edema legs?
M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
Thank you for your response, Dr. Vasavada. (Are you also able to see the additional information I posted in response to Dr. Sivak?)- No, he was not put on a prophylactic antibiotic, and he has not been given nitrofurantin. Great, I will ask my pediatrician about this option.- He has had his sodium levels checked a few times, since we were doing the blood draws anyway. Checked yesterday, and sodium was still within normal range. (Sorry, it may have been HYPOaldosteronism, rather than HYPER... The Endocrinologist thought his Aldosterone was most like the culprit for causing his body to lose so much sodium.)- His appetite has been low the past 2 months, and he lost ~8oz. - No signs of dehydration, puffy eyelids, or edema legs.
He could be having low adrenal steroid level (hypoadrenal) to cause low sodium. Please continue with periodic cultures of urine and other blood tests like CRP to detect bacterial infectionGood luck to him, he is safe if his creatinine etc are normal.
Thanks so much for the information!
You are welcome and good luck to him.
How is your child doing today?
He appears to be doing much better! No fevers for over 24 hours (none last night). And he's acting more like himself -- he's exploring toys, smiling/laughing, not fussy, longer naps.
VERY glad to learn that. Please ACCEPT if I answered your questions previously so that I may continue on JA site. All Best,
Pediatrician, Board-certified in Ped Hematology/Oncology
Just wanted to make sure that i "accepted" correctly so that you are compensated. Please let me know if I missed something, thank you!
Glad all is better with your son. All best,
Hello Dr. Sivak:
Thanks and all best,