3-Year-Old Female Patient Admitted to ER with Fever and Vomiting

Gabriela de Toledo Passos Candelaria, M.D.
Rio de Janeiro, Brazil

Case Summary

  • 3-year-old female patient, born and raised in São Paulo, Brazil
  • Previously healthy
  • Admitted to E.R. with a 2-d history of fever and vomiting
  • Right Otitis Media diagnosed in another service, treated with azithromycin.
  • Developed with worsening of symptoms and bilateral convergent strabismus, more accentuated to the right


  • Alert, fully conscious, oriented as to time and place
  • Right tympanic membrane with signs of inflammation
  • Bilateral convergent strabismus, more accentuated to the right


  • Ceftriaxone 100mg/kg
  • Right Mastoidectomy
  • Anticoagulation using 
  • Unfracionated Heparin (UFH)
  • No complications


  • Enoxaparin 1mg/kg/dose q12h
  • Neuro: Acetazolamide (Diamox) + Repeated lumbar punctures
  • Ophtalmologist: Ocular Buffer
  • Hb=9.8 / Hct=28 / WBC=14310 / Plt=4144k
  • Fibrinogen= 442
  • aPTT= 19.2s / R=0.69
  • PT= 13s / Prothrombin activity= 86%
  • D-Dimer=2116


  • Normal hearing
  • Resolution of strabismus
  • Absence of neurological sequelae

Patient Case Video

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