Fever, Hepatosplenomegaly, and Pancytopenia in a 5-Month-Old Infant

Hepatosplenomegaly in a young child can be an ominous physical finding, potentially representing a metabolic, malignant, or infectious process.We present the case of a 5-month-old girl who had fever, hepatosplenomegaly, and hematologic abnormalities at the initial examination.This case demonstrates how a comprehensive understanding of the pathophysiologic characteristics of hepatosplenomegaly and a systematic and thorough workup can help ensure that important diagnoses are not overlooked. Clinical Presentation (Kara Schmidt, MD):A previously healthy 5-month-old girl presented to James Whitcomb Riley Hospital for Children, Indianapolis, Ind, with a 1-week history of fever (temperature to 39.5°C), diarrhea, and irritability.The family denied that the infant had exhibited any respiratory symptoms or rash and reported only 1 episode of emesis.She had been evaluated at a local emergency department 4 days before presentation.The results of a chest radiograph and a urinalysis were normal; her parents had treated her symptomatically with acetaminophen and oral rehydration as instructed.When her fever continued and she became persistently irritable, she was brought to the Riley Hospital emergency department for further evaluation.The infant's birth history and medical history were unremarkable.Her development was normal, and she had no unusual dietary intake.The only medication she received was acetaminophen, and her immunizations were current.She lived with her parents and 3 sisters in a central Indiana farmhouse built in 1810, which was in the process of being remodeled.She did not attend day care and had no ill contacts, nor were there any exposures to barns, pets, or farm animals.Review of systems was otherwise unremarkable.