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An Infant With Periodic Fever

A 10-month old infant was seen in the emergency room with fever to 105°F for the past 2 days and 2 seizures, each lasting less than 5 minutes, 30 minutes prior to arrival in the hospital. This was the patient’s second episode of seizures accompanied by fever, with the first occurrence 1 month earlier. At that time, he was brought to the hospital and had a completely negative workup, including blood cultures, urinalysis, urine culture, examination of cerebrospinal fluid, and complete blood count (CBC). He was diagnosed with a viral infection associated with accompanying febrile seizure, given a dose of ceftriaxone, and his fever resolved within a few days. Beginning at 6 months of age, he had been seen by his general pediatrician every 3 to 5 weeks for fever up to 104°F. The episodes of fever lasted about 5 days total and presented with a normal physical exam, without any localizing infectious symptoms. They were diagnosed as viral infections and resolved within 3 to 5 days without antibiotic treatment. Noticing the trend, his mother began recording his daily temperature and plotted his febrile days (Figure 1). It became so consistent over time that his mother could accurately estimate the next febrile episode. The patient’s past medical history was negative for serious illness, hospitalizations, or chronic medical conditions other than stated above. He has had no prior surgeries and no family history of relapsing fevers. His review of systems was negative except as noted above. He lives at home with his mother and father. His mother is of French-Irish descent and his father is half Italian. Both parents and all grandparents were born in the United States. He has had no sick contacts, has not traveled outside of the state, and takes no medications. He has no drug allergies. His immunizations were up to date without any reaction or complications from the vaccines. Physical examination revealed a playful and pleasant well-nourished infant. Vital signs were as follows: temperature 102°F, blood pressure 107/45 mm Hg, pulse 136 beats/min, respirations 36/min, and pulse oximetry 98% on room air. Oropharyngeal examination was negative for aphthous ulcers, cobblestoning of the posterior oropharynx, tonsillar erythema, or exudates. maxillary sinuses were nontender to percussion. Neck examination revealed no thyromegaly. There was no cervical, auricular, axillary, or inguinal adenopathy. Cardiovascular exam was normal. His lungs were clear to auscultation bilaterally. His abdomen was soft, nontender, and nondistended. There was no hepatosplenomegaly. He had full range of motion at all joints with no swelling. Neurologic exam was physiologic. In the emergency department, his seizures were treated with diazepam and he was admitted for 24-hour observation after which time he was discharged.