Case presentation A 5-month-old boy was presented to the emergency department with fever, irritability, and vomiting. He had a rectal temperature of 38.0°C. He vomited five times since the onset of the fever, which was 8 hours ago. He was fed soy formula. His past medical history was unremarkable. Examination: VS T38.0R, P150, R40 (crying), BP unobtainable, weight 50 percentile Fussy, though consolable at times. He did not focus or interact well and appeared somewhat "toxic." Anterior fontanelle was difficult to assess due to continuous crying but appeared almost full. Eyes were moist.
Pupils were reactive. Trabecular meshwork was shiny and slightly red. The oral mucosa was moist. The neck was hard to assess due to crying. The heart was observed to be normal without a murmur. Lungs were clear, and the abdomen was soft on inspiration. No detectable tenderness was evident. No hernias.…
