Clinical Case 1

You are approached by Dr Pattinson, a junior colleague who has assessed George, a 2-year-old boy brought to the emergency department by his mother. George has had a fever for the past week which is not improving despite regular paracetamol and ibuprofen. He has been increasingly irritable over the last 48 hours. George’s past medical history is of one episode of tonsillitis four months ago. He does not take any regular medications, is up to date with his childhood vaccinations and has two sisters who are both well.

On examination George is alert but clinging onto his mother, febrile at 39.2°C and tachycardic. His work of breathing is normal and his chest is clear on auscultation. His abdomen is soft and non-tender, with no rashes noted. ENT examination is unremarkable. Urine dipstick was negative.

Dr Pattinson has asked you to review the patient as she cannot find a source of infection.