Fever and Odynophagia in a 4-year-old Girl.

1. Peter Cosgrove, MBBChBAO* 2. Kartik Pillutla, MD† 1. *Department of Emergency Medicine, Boston Children’s Hospital, Boston, MA 2. †Department of Pediatric Nephrology, Dell Children’s Medical Center, Austin, Texas A 4-year-old girl presented to the emergency department with a 2-day history of fever, poor oral intake, and nasal congestion. Three months prior she received a deceased-donor renal transplant for end-stage renal disease due to diffuse mesangial sclerosis. Prior to transplant she was Epstein-Barr virus (EBV) immunoglobulin G negative. The patient was on standard immunosuppression after her transplant including tacrolimus, mycophenolate mofetil, and prednisone. In the emergency department she had a low-grade fever and bilateral pharyngeal tonsillar exudates without trismus. She had a positive result on rapid EBV testing and a negative rapid streptococcal test result. Eight days later she developed worsening shortness of breath, loss of appetite, and lethargy. In the emergency room she was found to be in …