A 7-week-old boy is admitted to the pediatric intensive care unit because of decreased oral intake, poor latch, and decreased energy. He had not taken anything orally for 12 hours. He presented to an outside emergency department hypothermic, hypotensive, lethargic, and pale. He had previously been feeding normally with no pertinent birth/medical history.

Vitals:

• Temp 35.3 °C
• HR 140–150s
• BP 70/20–30 mmHg
• RR 40s

Labs:

• CBC: Hgb 1.8 g/dL, WBC 4.8 x 10³/mcL, platelets 65 x 10³/mcL, MCV 114 fL, RDW 14.5%, ANC 400
• BMP: Na 141, K 4.5, Cl 109, bicarb <10, BUN 28, Cr 0.53, glucose 65
• LFTs: AST 962, ALT 683, Tbili 1.8
• CRP 0.6 mg/dL
• COVID 19 (+)
• BCx and UCx pending

Based on the clinical presentation and laboratory evaluation, what is your leading differential diagnosis?

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Shailly Gaur, MD; Shannon Carpenter, MD
Division of Pediatric Hematology Oncology & BMT
Children’s Mercy Hospital
Kansas City, MO, USA

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Categories: Case Quiz