Fever and Seizure Activity in a 10-Month-Old Boy

A previously healthy 10-month-old boy presented to the emergency department (ED) with his mother following a generalized tonic-clonic seizure. Two days prior to presentation, the patient had a fever to 103°F, was acting more fussy than usual, and developed a decreased appetite. He later had 2 episodes of nonbloody, nonbilious emesis and was taken to his pediatrician, who diagnosed him with acute otitis media and prescribed azithromycin. Symptoms persisted, and on the night of presentation to the ED, the patient was febrile and had an episode where he screamed, grabbed his head, and went limp for a brief time. This was followed by a generalized tonic-clonic seizure. He continued to seize while en route to the ED. In the ED, the patient received diazepam, lorazepam, and a loading dose of phenytoin before the seizure activity abated after almost 2 hours. Shortly thereafter, he developed respiratory failure requiring intubation (caused by the antiepileptic medications). Once the patient’s airway was secured, initial blood work and cultures were obtained, and he was given an initial dose of ceftriaxone. He was transferred to the pediatric intensive care unit (PICU) of a tertiary care center for further care. The patient’s past medical history included a prior hospitalization at age 2 months for pneumonia. The prenatal course was uncomplicated, and he was born at term. Developmental milestones were met with no delays noted by his pediatrician. He took no medications regularly and had no known drug allergies. His immunizations were current except for the pneumococcal conjugate 7-valent vaccine (PCV7), which was not routinely administered at his pediatrician’s office.