An Eight-Year-Old Child with Fever, Fatigue, Pallor, and Weight Loss

An 8-year-old previously healthy Hispanic boy presented with fever and a 10-lb weight loss over the past 2 months. His fever has occurred almost daily, reaching 102°F. The fever was noted to be slightly higher and more frequent at nighttime, with occasional chills. He defervesced without the use of antipyretics. Shortly after the fever began, the child developed an erythematous rash on his lower extremities. An unknown antibiotic produced resolution of the rash after 1 to 2 days. Several weeks before presentation, he developed a productive cough, green rhinorrhea, and post-tussive emesis. Results of blood tests performed at that time were normal, and he was symptomatically treated for a virus. However, the parents became concerned about the child's increasing pallor and fatigue. When they returned to the pediatrician, a complete blood count (CBC) revealed anemia of an unknown degree. He was then referred to the emergency department (ED) for further evaluation. The review of systems was notable for a decreased appetite and energy level. Otherwise, it was negative for diarrhea, constipation, and abdominal pain. Furthermore, he had no headaches, mental status changes, bruising, epistaxis, hematuria, or dysuria. History was also negative for travel and ill contacts. Over the past 5 months, there had been reconstruction at his school, and there was a rodent infestation at home. The child took no medications and had an allergy to amoxicillin, with which he developed a rash. He was a fullterm neonate, born in Los Angeles, Calif, delivered by cesarean section secondary to fetal distress and bradycardia, with a birth weight of 8 lb 9 oz. His mother received first-trimester prenatal care, with unremarkable study results. He had no prior hospitalizations or surgeries.