Case presentation A previously healthy 3-year-old boy was bought to the ED with four weeks of unknown fever. He was diagnosed with pharyngitis and otitis media, for which he received a complete course of azithromycin and amoxicillin. However, despite the antibiotics, his fever continued to rise to 102.5 F daily.
He began to experience weight loss, non-productive cough, fatigue, and constipation. Physical examination upon presentation: Temperature: 101.7 F Heart rate: 135 beats/min Respiratory rate: 20 breaths/min Dry mucous membranes Posterior cervical lymphadenopathy Cardiovascular examination: Normal Respiratory examination: Normal Pharynx erythema (no tonsillar exudates) Mild abdominal distention (without significant tenderness or organomegaly) Delayed capillary refill (4 sec) Other examination: Normal Blood cultures were positive for Enterococcus faecalis. A thoracic echocardiogram…
