A 7-year-old boy presented to the emergency department (ED) with fever, headache, and cough for 2 days. He was presumptively treated with oseltamivir for suspected influenza infection and discharged from the hospital. He returned to the ED the following day with new painless bilateral asymmetric eyelid swelling and right jaw pain; he remained febrile. At that time, he was treated for a suspected allergic reaction to oseltamivir (which was discontinued) with oral diphenhydramine. The next day, he returned to the ED with history of continued fever after developing worsening eyelid swelling and new pain with eye movement.
His vital signs on arrival during the third ED visit demonstrated an afebrile (98.6°F [37.0°C]), tachycardic (148 beats/min), normotensive (102/49 mm Hg) child with a respiratory rate of 24 breaths/min and oxygen saturation of 95% on room air. His physical examination was notable for significant bilateral eyelid swelling. Additionally, he had right-sided trismus...
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