Age: 4.0
Sex: F
Vaccine: MMR
Symptoms: Bacterial test, Biopsy bone marrow abnormal, Blood test, C-reactive protein increased, Central venous catheterisation
Clinical narrative: On Oct 29, 2018, pt began complaining of pain in her left leg. She continued to play and baby the leg slightly. We looked at it to see if there was a bump, bruise or mark, but we did not see anything. The next day, Oct 30th, 2018, pt woke up in pain, saying her knee/leg hurt. She had a lot of trouble putting weight on it and I noticed she was hot, so I took her temp and she had a low fever. I gave her Tylenol, and within 30 min she was walking normally and her fever had gone down. She went to school, because there were no signs of any congestion, cough, sore throat, or anything respiratory- besides the leg pain and very low fever (100.1-100.3). I picked her up from school that day and the teach told me she had been fine all day - playing and acting normal, until she woke up from her nap (2:15 end of the day). I walked in and she was on the floor, telling me she couldn't walk. I asked her where it hurt and she said her leg. So I picked her up and carried her out. When we got home her fever was higher than before - 101.5-101.8. I gave her Tylenol once again and about an hour later her pain was gone and so was the fever. She was walking around and playing like normal. She went to bed and woke the next morning (Oct 31st) and has some pain and low fever (100.1-100.4), but was walking. She went to play at the museum in town, had lunch and went down for a nap. When she woke up around 3pm she was in  a lot of pain. We decided to take her into Urgent Care because it was day 3 and did not seem to be getting any better. They sent us to the local hospital and we were seen right away. The began an IV and took blood. They saw elevated white blood cell counts and told us it was indicative of an infection somewhere in the body. They gave her Tylenol and transferred us to Hospital. We checked into the ER and were seen by several doctors - they too took blood and confirmed the high white blood cell count and elevated CRP levels in her blood - indicating infection. They decided to keep her overnight to watch her. The next day, Nov. 1st they began running blood tests for bacterial infection and an infectious disease doctor and Oncologist came in to assess pt and sort of get the history of what had been happening with her. The next day, Nov. 2nd, we began IV antibiotics. We continued on the antibiotics and are still currently on them via PICC line. Over the next days Nov 3-9, we did two MRI's, a CT scan, bone marrow biopsy, PICC line insertion and the only thing they could find was that the bone marrow appeared to be darkened on the MRI - in the same place on both MRI's. There was no abscess, or "highlighted" areas on the scans to indicate "infection", however they would treat this as Osteomyelitis, since the antibiotics did seem to space her fever out further, and make the pain go almost completely away as well. We left on 11/11/18 with the PICC line and order of IV of antibiotics to complete at home over the next 3 weeks. We go for our follow up visit today, 11/15/18 to read further blood test results, etc.