History of present Illness

 A 7-month old girl developed fever to 38.9C with cough, rhinorrhea, and loose stools .

 over the next few days, the respiratory symptoms and diarrhea resolved, but her fever persisted.

History of present Illness

 Six days before admission she was evaluated by her primary pediatrician and diagnosed with cellulitis involving labia majora.

She was treated with cephalexin,

 she presented to the “ Emergency Department “because of continued fever and worsening cellulitis and was admitted for IV Antibiotic and additional evaluation

Past Medical History

 Her birth history was remarkable for unconjugated hyperbilirubinemia her blilirubin level peaked at 16 mg/dL and returned normal without phototherapy .

 Two months before admission she developed otitis media and resolved with a 10 days amoxicillin

 Cephalexin was only medication at the time of admission    

Physical Examination

 T, 40.3 c ; RR, 50/min; HR, 160 bpm

 BP, 104/60 mmHg; SpO2, 98%

 Weight, 75 percentile

 Not toxic appearing infant

 Anterior Fontanel was open & flat

 Tympanic membranes were mildly erythematous

Physical Examination

 The Heart & Lungs were normal

 The Spleen was palpable

 Genitalia revealed erythema & induration of the left Labia majora with mild fluctuance

Diagnostic Study

 WBC 3100/mm3,with 2% segmented N, 28% M & 70% L,

 The absolute neutrophil count ( ANC) was 62 cells /mm3

 Hg was 12.3 mg/dL

 Platelet were 337000

 Lactate dehydrogenase & uric acid N

 U/A N ,U/C, BC negative

Course of IIIness

 Gr. Staining after percutaneous drainage of labial abscess demonstrated many Gr.-ve rods

 She received Antibiotic for Staph. Aeureus  & Gr –ve organisms P. aeruginosa

 Gentamicin was added to provide additional coverage

 B.M. aspirate was done

Course of IIIness

        What is the patient's possible diagnosis?