“She has a fever.” The case of JuJu F. Chief Complaint: Fever. Clinical History: JuJu F. was a six-month-old girl brought in the morning to a pediatrician’s office by her mother, who said, “She has a...

“She has a fever.” The case of JuJu F.

Chief Complaint: Fever.

Clinical History: JuJu F. was a six-month-old girl brought in the morning to a pediatrician’s office by her mother, who said, “She has a fever.” She added that JuJu had been irritable and “feverish” for several days because of “a cough and a runny nose.” She became especially concerned the night before when JuJu became increasingly irritable, vomited, and began pulling at her left ear. She took JuJu’s temperature with an electronic ear thermometer and found it to be 102°F. JuJu had no previous medical problems. She had received no medicine at home other than acetaminophen.

Physical Examination and Other Data: Physical examination revealed a healthy infant girl crying in her mother’s arms. Temperature was 101.8°F. Heart rate and respirations were rapid but not unusual for a child with fever. Crusted mucus was present around the nostrils and the child was mouth breathing. The chest was clear, and cardiac sounds were not remarkable. The neck was supple, and the anterior fontanel was small, soft, and flat. The right ear was normal, but the left tympanic membrane was bulging, dull and red. Clinical Course: The pediatrician made a diagnosis of acute otitis media (AOM) and wrote a prescription for an oral antibiotic. A follow-up visit was scheduled in two weeks. The office PA made a follow-up call the following morning. JuJu’s mother reported that JuJu’s temperature was 99°F and her appetite had improved. On follow-up two weeks later, JuJu was found to be happy and asymptomatic, but she had serous effusions in both middle ears. The pediatrician explained that effusions frequently occur but are not serious unless they persist for several months. Another follow-up visit was scheduled in six weeks. When she returned, the effusions had disappeared and she seemed perfectly normal.