title: A 34-Day-Old With Fever, Cerebrospinal Fluid Pleocytosis, and Staphylococcus aureus Bacteremia.
abstract: A 34-day-old previously healthy boy born full term presented to the emergency department with fever at home (38.1°C), fussiness, and decreased oral intake for 1 day. He was difficult to console at home. He had decreased oral intake without emesis, diarrhea, or a change in urine output. He did not have rhinorrhea, cough, or increased work of breathing noted by parents. He lived at home with his parents and 13-year-old brother, did not attend day care, and had no sick contacts. On examination, he was fussy but consolable. He was febrile to 39.3°C, tachycardic (180 beats per minute), and tachypneic (64 breaths per minute), with mottling and a capillary refill of 3 seconds. The remainder of his examination was normal, without an infectious focus for his fever. A complete blood cell count with differential revealed leukocytosis. A basic metabolic panel was normal. A catheter urinalysis was normal. Cerebrospinal fluid examination yielded pleocytosis, low glucose, and elevated protein. Blood cultures were persistently positive with methicillin-sensitive Staphylococcus aureus, but cerebrospinal fluid cultures remained negative. We present his case, management, and ultimate diagnosis.
authors.affiliation: Divisions of Department of Pediatrics, Emergency Medicine, kimberly.horner@chp.edu.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Horner
authors.affiliation: Infectious Diseases, and.
authors.forename: Masaki
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Departments of Radiology and.
authors.forename: Giulio
authors.initials: G
authors.lastname: Zuccoli
authors.affiliation: Allergy and Immunology.
authors.forename: Stacy
authors.initials: S
authors.lastname: Rosenberg
authors.affiliation: Neurosurgery, The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Greene
authors.affiliation: Diagnostic Referral Group, and.
authors.forename: Kishore
authors.initials: K
authors.lastname: Vellody
authors.affiliation: Divisions of Department of Pediatrics, Emergency Medicine.
authors.forename: Noel S
authors.initials: NS
authors.lastname: Zuckerbraun
mesh_terms: D016470:Bacteremia; D002574:Cervical Vertebrae / Q000473:pathology*; D003937:Diagnosis, Differential; D020802:Epidural Abscess / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005334:Fever; D006801:Humans; D007223:Infant; D007964:Leukocytosis / Q000134:cerebrospinal fluid; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification*