Lily, a 6-Month-Old Girl with Fever and Lethargy

Abstract

CASE PRESENTATION Lily is a 6-month-old girl with no significant medical history who presented to her pediatrician’s office this morning with fever and increased sleepiness. Her pediatrician was concerned by her lethargy, so he referred her to the emergency department (ED). In the ED, a diagnostic evaluation is initiated, including serum laboratory studies, blood cultures, lumbar puncture (LP), chest radiograph, and a urinalysis with urine culture. The results of the laboratory studies are pending, but the ED physician reports that the chest radiograph is unremarkable. Lily receives an intravenous (IV) fluid bolus of 20 mL/kg normal saline and is given empiric ceftriaxone and vancomycin. The ED physician calls you to evaluate Lily for admission to the inpatient unit. After speaking to the ED physician caring for Lily, you begin your patient evaluation.