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I have a 15-month-old son that has had a persistent fever of…

Hello. I have a 15-month-old...
Hello. I have a 15-month-old son that has had a persistent fever of 102 and higher for more than two weeks now. Have been to the ER when fever got to 104 and seen pediatrician twice. He had an ear infection two weeks ago and was treated with amoxicillin for 10 days. Fever still remains. He's lethargic. He vomits from post-nasal drip almost daily. We treat him with a saline nebulizer and Allegra but it doesn't help. Chest x-ray was clear and lungs still sound clear. We are at wits end frustrated. Any ideas? We are considering taking him to Cook Children's in Fort Worth, TX, (about 4 hours from our home) because we just don't know what to do and our local providers seem to keep dismissing. I'm a healthcare professional and about to finish my BSN-RN and don't feel we are overreacting.
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Customer reply replied 28 days ago
Flu and strep tests have been negative also
Answered in 2 hours by:
3/25/2018
Richard Han
Richard Han, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 964
Experience: Pediatrician with over 15 years experience
Verified
Hello my name is***** am a board-certified pediatrician with over 15 years of clinical experience and I am here to help you. A little background please: has your son be routinely vaccinated? Any chronic medical conditions or medications taken regularly? Any blood, urine or diagnostic imaging done so far other than what you listed above? As regarding the fever, just to be clear has he had a measured temperature of 101 F or greater for 14 days in a row? (i.e. >101 F at least once every 24 hours x14 days consecutively, even while on amoxicillin?)
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Customer reply replied 27 days ago
There hasn’t been a day over last two weeks where there wasn’t some type of fever. It most often will hover around 102. He is up to date on all vaccinations.No other lab work or imaging other than clear chest x-ray.We’ve alternated 3.75 ML Tylenol and 4 ml ibuprofen for the fever. Even while on the amoxicillin he would just randomly spike a fever. It won’t be there all the time but it has be present essentially daily.I took him to the ER 17 days ago when his fever hit 104 and they just said upper respiratory. 3 days later had bilateral ear infection. That’s when amoxicillin was started and 10 day course was completed. No swollen lymph nodes as far as I can tell. No red spots on tongue.
Thank you for all that information. I’m assuming even if he has some decreased appetite he’s still drinking and urinating, and not having any respiratory distress, since he’s not been admitted. At this point your son definitely requires further diagnostic work up. (to be cont’d)
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He doesn’t sound as if he needs a children’s hospital per se but if that’s the only way to get answers sooner than later, I would recommend it. At the very least he needs routine screening blood tests and an x-ray. I would suggest a urine as well. In my opinion there are multiple possibilities but at the top of my list would be viral infections such as Epstein Barr virus (EBV) which causes mononucleosis in older children but is a common cause of fever of unknown origin, which is where he is at now. Other possibilities include pneumonia or an occult abscess one way another it’s not just a viral URI or ear infection at this point and someone needs to looked deeper and harder. Can I help with anything else today?
Richard Han
Richard Han, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 964
Experience: Pediatrician with over 15 years experience
Verified
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Customer reply replied 27 days ago
That helps me quite a bit. Never thought of EBV. Kids this young can be asymptomatic other than the fever, correct? His lungs sound clear to me. We will get his pediatrician to order lab work and urinalysis. Thanks for your input.
You’re very welcome. Yes, EBV can present as nothing but prolonged fever, even in his age group. I hope your pediatrician helps you find some answers soon. Take care.
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Richard Han
Richard Han
Richard Han, Board Certified Pediatrician
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