A 10-month-old Hispanic female presents to the emergency department with a chief complaint of being limp. The mother states that the first day of the child’s illness began with tactile fever. The patient did not have any diarrhea or vomiting. After presenting to the emergency department she was diagnosed with a left otitis media. At that time, intramuscular ceftriaxone was given and amoxicillin was prescribed. The second day the patient was doing well and there were no new problems. On the third day the patient woke up and was not moving her arms and legs as much as usual, did not want to sit up on her own, and was lying limp. Additionally, she had some decreased oral intake that day and one loose stool.
Upon follow up at the pediatrician’s office there was concern about how limp the child seemed and she was sent back to the emergency department for transfer to the children’s hospital. However, the emergency department did blood work, gave intravenous fluids, and after observing slight improvement in limb movement, discharged the child to home.
At home, the child spiked a temperature. She was brought to the pediatrician’s office the next day where slight improvement in movement and more alert affect were noted; however, concern remained regarding her overall decreased activity. The child was again sent to the emergency department for transport to the pediatric hospital.
Review of systems revealed one vomiting episode and one loose stool, slight runny nose, and decrease in oral intake 1 day prior to admission. They had recently returned form California from a weekend trip. There was no significant past medical history aside from an otitis media 4 months ago. The child was born full-term without any complications. The child does not take any chronic medications, but did take two doses of amoxicillin for one and a half days in addition to acetaminophen for fever. The child does not have any known allergies. Her diet includes breastmilk and table foods. Six month vaccinations are not completed, but prior vaccines had been given on schedule. The child lives with her mother only and family history was not significant. Developmentally the child rolled over at 4 months, sits without support, pulls to stand, and stands with help.