Case Study: 8-Year-Old With a Murmur and Hypertension

An 8-year-old female presents to the emergency department (ED) referred by her primary care provider (PCP) for left-sided neck swelling and murmur. Per the patient’s mother, the patient has had left-sided neck swelling for 1 month. The patient also experienced subjective fevers, chills, headaches, and malaise. Over that same period, mom also noticed about 5 pounds (2 kg) of weight loss and intermittent side pain. Because of these concerns, mom took her daughter to the PCP 2 weeks before ED presentation and was diagnosed with lymphadenitis and started on oral amoxicillin-clavulanic acid and told to follow up the following week. At the following visit, there was a minimal improvement of the neck swelling, so the patient was switched to oral clindamycin. After a week of being on the clindamycin, the patient presented again to the PCP with minimal improvement of her symptoms. At this visit, the PCP also noticed a new cardiac murmur. Because the patient had failed outpatient antibiotic therapy and had this new heart murmur, the PCP referred the patient to the ED.