A 3-Year-Old Boy With Fever and Drowsiness

Gavin Christian K.W. Koh, MB, BChir, MA, MRCP, DTM&H; Richard J. Maude, BSc, MBChB Hons, MRCP, DTM&H; Pramot Srisamang, MD


July 28, 2017

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A 3-year-old boy presents to the emergency department of a regional hospital in northeast Thailand 4 days after falling into a well. The patient's relatives estimate that he was in the water for no longer than 5 minutes and that he may have aspirated a significant amount of water. He did not lose consciousness and appeared to recover completely within minutes. Three days later, however, the boy developed a fever, cough, and increased drowsiness that prompted his family to bring him to the emergency department.

The child has never been to a hospital before, is normally fit and well, and is on no regular medications. He comes from a family of rice farmers and often plays in the paddy fields near his home. Both parents and siblings are well-appearing, and the family history does not include diabetes, thalassemia, or renal disease.


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