Case 3: Persistent Fever in an 8-month-old Boy

An 8-month-old unimmunized fraternal-twin boy, born at term, presents to the hospital with fever, cough, rhinorrhea, and right-sided neck swelling with drainage. On history, the fever and neck swelling began 7 weeks earlier, at which time he presented to a rural hospital where ultrasonography confirmed a cervical lymph node abscess. The abscess spontaneously drained and was positive for Staphylococcus aureus. He was treated with intravenous (IV) cefotaxime for 6 days, followed by 14 days of oral cefuroxime. The fever resolved completely after 4 days of treatment, but the neck lesion continued to drain during the next 7 weeks. One week before his presentation to our hospital, he had recurrence of daily fever (to 104°F [40°C]) associated with neck drainage, cough, and rhinorrhea. Further history reveals an otherwise healthy infant boy with normal energy, appetite, and appropriate development. There is no history of weight loss, night sweats, or risk factors for...