What is wrong with these kids? (Mystery Diagnosis) - page 4

by Ashley, PICU RN

12,626 Views | 49 Comments

My area has recently seen 3 children at 2 separate facilities present with eerily similar and so far undiagnosed problems. Similar age group, but nothing else in common (different locations, ethnicities, no similar contacts or... Read More


  1. 1
    OP, what state are you in? Any exposure to wildlife, pets, insects? What about the soil, water, etc -- could this be environmental? You've got us all so curious and I hope you'll be back to post the denoument!
    anotherone likes this.
  2. 0
    Any answers what could be causing?
  3. 0
    A ten-year old boy presented with AMS in our ED today and all work-up was negative. He wasn't my patient, so I can't say what happened to him, although I believe he was admitted. Please let me know where you are located ASAP. You can message me. Thanks.
  4. 0
    Fascinating and terrifying.

    Was the CSF checked for West Nile, by any chance? I know it's not really mosquito season but you never know...

    We had a lady with West Nile and everyone was baffled...diagnosis didn't come back until after she died, though.
  5. 2
    Any updates? My curiosity is surely peaked!
    anotherone and marycarney like this.
  6. 0
    I was also wondering about West Nile.
  7. 0
    Look at what they have been eating. May be due to pesticides/herbicides on fresh foods.

    Also check whether they have had immunizations recently.
  8. 2
    No PMH. All of these patients were healthy previous to their admission. Immunizations UTD on most, with no recent vaccinations in the past 6 months. CSF and blood was sent for a viral panel- I'm not sure if West Nile is included in these results but last time I checked the full results of the viral panel were still pending for the one patient left on our unit (the other was transferred at the request of the understandably frustrated parents searching for answers).

    The operating assumption is unspecified viral encephalitis. And actually, the patient on our unit is improving slowly and was actually extubated recently. The other three, to my knowledge, remain intubated. I suppose it's possible that we may never know exactly what caused this, which would be a rather anti-climactic end to this thread.

    Because of the similar symptoms, it seems like their has to be something in common, but so far nothing has been noted. Different locations, different schools, never met before, no similar contacts that we know about, no school trips, and we live in a fairly urban area so there is limited contact with exotic animals. Pets are an option, but in four separate households it just seems strange. Something environment you'd expect a more wide-spread outbreak.

    I'm in NJ and I'd rather not specify any more than that. To my knowledge the CDC is not involved yet, although there has been talk of bringing it to their attention.
    Esme12 and tewdles like this.
  9. 1
    Thanks for the update. I think about this thread often. It's just too coincidental with the demographics, don't you think?
    anotherone likes this.
  10. 2
    Quote from Ashley, PICU RN
    No PMH. All of these patients were healthy previous to their admission. Immunizations UTD on most, with no recent vaccinations in the past 6 months. CSF and blood was sent for a viral panel- I'm not sure if West Nile is included in these results but last time I checked the full results of the viral panel were still pending for the one patient left on our unit (the other was transferred at the request of the understandably frustrated parents searching for answers).

    The operating assumption is unspecified viral encephalitis. And actually, the patient on our unit is improving slowly and was actually extubated recently. The other three, to my knowledge, remain intubated. I suppose it's possible that we may never know exactly what caused this, which would be a rather anti-climactic end to this thread.

    Because of the similar symptoms, it seems like their has to be something in common, but so far nothing has been noted. Different locations, different schools, never met before, no similar contacts that we know about, no school trips, and we live in a fairly urban area so there is limited contact with exotic animals. Pets are an option, but in four separate households it just seems strange. Something environment you'd expect a more wide-spread outbreak.

    I'm in NJ and I'd rather not specify any more than that. To my knowledge the CDC is not involved yet, although there has been talk of bringing it to their attention.

    I have ready over this many times, and I am always happy to see updates. It has become about of a diagnostic challenge for me and I oft consider what my impression would be if I was the provider (though I haven't seen kids in a while).

    Viral encephalitis would have been my primary working dx, given the presentations.

    I would consider the zebras:

    Murine typhus, ADEM, RMSF, Q fever.
    Esme12 and tewdles like this.


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