{'fraction_non_alphanumeric': 0.0351668169522092, 'fraction_numerical': 0.034715960324616775, 'mean_word_length': 4.80890052356021, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 3, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Fever in a 15-Year-Old Boy With Spinal Cord Injury

A 15-year-old boy with a history of ischemic spinal cord infarct with resultant partial lower extremity paraplegia and neurogenic bowel and bladder presents with fever of unknown etiology, 2 days of chest pain, and 5 days of increased bilateral lower extremity weakness. He arrives from a referring institution with a normal chest computed tomography (CT) angiogram, troponins, and basic metabolic panel. His chest X-ray reveals mild elevation of his left hemidiaphragm. Electrocardiogram and echocardiogram are normal. Laboratory results reveal a white blood cell count of 15 820/μL (15.8 × 109/L). A complete spinal magnetic resonance imaging with contrast revealed stable myelomalacia, most prominent at T1-T2 level. Urine culture is negative. On hospital day 2, the boy is still intermittently febrile. Repeat laboratory results reveal an improved white blood cell count of 5860/μL (5.86 × 109/L) with 94.6% neutrophils, a C-reactive protein of >27 000 mg/dL. Blood cultures are negative. Urine toxicology is negative. On hospital day 3, a fluctuant mass is noted at the level of T12, repeat blood cultures are drawn, and the patient is started on clindamycin for a suspected abscess. Ultrasound of the lesion as well as blood cultures and stool cultures were negative. On hospital day 4, chest pain resolves but fever persists, and the patient develops abdominal discomfort. Vital signs reveal a temperature ranging from 37.8°C to 38.9°C, systolic blood pressures 104 to 166 mm Hg (10th percentile to >99th percentile; Figure 1), diastolic blood pressures 42 to 96 mm Hg (2nd percentile to >99th percentile; Figure 2), heart rate from 84 to 138 beats per minute, and respiratory rate from 23 to 36 breaths per minute. The boy appears uncomfortable but cooperative. His abdomen is firm, slightly distended, diffusely tender, and tympanitic with hypoactive bowel sounds. There is no rebound or guarding. He has lower extremity weakness and decreased sensation bilaterally beginning around the T7 dermatome, which is unchanged from his baseline. The remainder of his examination is within normal limits. Further diagnostic imaging reveals the diagnosis. Discussion