History of Present Illness:
A tween female presents to the ED for 3 days of fever and generalized headache without vomiting, neck stiffness or photophobia and one day of midsternal non-radiating, non-exertional, non-pleuritic chest pain. She denies any cough, shortness of breath, sore throat or other complaints. The maximum recorder temperature was 102.1 in past 24 hours
Vital Signs & Physical Exam:
Vital signs are normal except for temperature of 99.3. Physical exam is otherwise normal including no tachycardia, rub or peripheral edema
Initial Diagnostic Testing:
- CBC: normal except for 77% PMN’s
- Chem 7: normal
- Imaging: EKG normal
What additional testing should you consider? (may select more than one)
- Influenza swab
- Troponin
- CXR
- ESR
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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ANSWERS: All are correct
- Influenza swab – negative
- Troponin – elevated at 8.3 (normal <0.04)
- CXR – negative
- ESR – elevated at 42
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CASE CONCLUSION: Admitted to hospital. Did well. Cause determined to be Parvovirus B19
CASE LESSONS:
- Myocarditis is rare but when there is fever and chest pain in a child that you can not confidently attribute to a cough, further testing should be considered, just as you would in an adult. Other findings that should make you consider myocarditis is unexplained tachycardia, findings worrisome for CHF, even if mild, or abnormal ECG.