University of Medicine and Pharmacy, Iasi, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Fever of unknown origin is defined as a rectal temperature higher than 38.3°C
more than 3 weeks, the diagnosis of which remains uncertain after initial investigations. Identification
of the causes and management of prolonged fever in children is important and is guided by thorough
history-taking and repeated physical examinations combined with standard laboratory tests and simple
imaging procedures.
Clinical case: We report the case of a two-years-old male who had been managed 1 week for
rinofaringitis at home and for 6 days in a tertiary clinic were had been placed on various intravenous
antibiotics with no clinical improvementand and was finally referred for further management to our
hospital. Physical examination revealed pyrexia (temperature of 38.2°C), faringeal congestion and
injected tympanic membranes.The signs of meningeal irritation were absent. Other aspects of physical
examination were normal. Results of laboratory tests showed nothing of significance apart from
anaemia. He received antibiotic treatment. The fever persisted and in 3-rd day of hospitalisation the child
becomes drowsy and father describes cutaneous hyperesthesia. The cerebrospinal fluid analysis showed
features in keeping with meningeal inflammation and he had a raised erythrocyte sedimentation rate.
The brain computed tomography scan revealed a tetraventricular hydrocephalus. He had ventricular
shunt and was placed on antituberculous drugs and intravenous steroids but despite this his clinical
condition slowly ameliorated and he developed right spastic hemiparesis.
Conclusion: The diagnosis of TB meningitis in this patient highlights that when a patient is not
obviously exposed to the causative factors of a disease and clinical signs are absent, possible occurrences
may present a diagnostic problem
