What could be the reason for high-grade fever and abnormal blood values in children?

Question

Hello doctor,

My 2-year-old son who is soon going to be 3 has had three episodes of high fever (over 103.7℉ - 105.3℉) without any symptoms. He had a similar history previously, but I thought it to be a simple viral infection and never paid attention to it. He often wakes up with a very high fever and it lasts anywhere between one to four days. During the last episode, he complained that his legs and feet hurt. The first episode of fever was after a week following his first birthday. I gave Advil and Tylenol to reduce the fever.

There are no signs of swelling or rash. This happened two months back and has now recurred again. The pediatrician suggested a few lab tests to be taken and several values are not within the normal limits and a few seem to be very high. From the results, the doctor said that it is indicative of an inflammatory response and an elevation in WBC. As of now, the doctor wants us to continue documenting his episodes and observing him. Overall, he appears healthy and happy. He has a sensitivity to lactose but there are no other significant health issues. Should we do any additional testing? Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I am happy to be of help to you.

There are certain vital points that I have noted from your history:

1. Repeated episodes of documented fever are not normal.

2. The fever is always a high grade above 102℉ but the child appears healthy.

3. The child is complaining of leg and foot pain.

4. The reports (attachments removed to protect the patient’s identity) show a high count of WBCs (white blood cells) and neutrophils. Also, the RBC (red blood cell) count is low and the levels of CRP (C-reactive protein) and alkaline phosphatase are elevated.

All these issues seem to be pointing to a likely hematological issue. I advise you not to take this lightly, and I would suggest you take the following tests:

1. Firstly, you can check if the child has any inflamed lymph nodes and whether the spleen or liver is enlarged. You can surf the internet to know how to do this.

2. Secondly, do Hb (hemoglobin) electrophoresis, I: E ratio from CBC (complete blood count) report, serum LDH (lactate dehydrogenase) iron studies, and serum ferritin. If the reports are indicative of any hematological issue, I suggest you perform a bone marrow biopsy to confirm the diagnosis. Your child may require consultation from a hematologist also.

Feel free to revert if you need further clarification.

Thank you.