The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
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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Cite this: Gavin Christian K.W. Koh, Richard J. Maude, Pramot Srisamang. A 3-Year-Old Boy With Fever and Drowsiness - Medscape - Jul 28, 2017.