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You are seeing a 10 year old recently moved to the U.S. from Mexico with left sided chest pain for one day, and a fever to 38.2. Lung sounds are clear, the O2 sat is 100% on room air, and the CXR is negative. The ECG shows diffuse 1mm ST elevations and PR depression. The patient is well appearing with normal vital signs and hemodynamics.
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June 19, 2018 at 4:19 pm
A. PPD and NSAIDS. The patient presents with signs of pericarditis, including chest pain, low-grade fever, and ECG with diffuse ST elevation, and PR depression. A pericardial friction rub would be pathognomonic for pericarditis. The most common cause is viral (so would not start antituberculosis medications empirically), although TB is a potential cause. A pericardial effusion requiring pericardiocentesis would presumably result in hemodynamic instability or at least tachycardia.