4year old with high grade fever with chills since 1 week ,hepatosplenomegaly cheilitis red tongue ,started on monocef since 3days ,no resolution of spikes ,amikacin added after 48 hrs but no respite.

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Rule out kawasaki disease.. As fever and red tongue probably strawberry tongue are present look for other features of kawasaki disease here. Also there is Anemia and leucocytosis which are also lab features of kawasaki disease. Do LFT with serum proteins to look for hypoalbuminemia and elevated serum transaminases and raises GGT. URINE routine microscopy to look for sterile Peoria. Ultrasound abdomen for edema around the gall bladder. Do esr and crp also. Csf should be done to look for aseptic meningitis as it is also a feature of kawasaki disease.

Sterile pyuria

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by cheilitis red tongue do you mean strawberry tongue because Kawasaki disease can have unremitting fever,conjunctivitis, strawberry tongue, and unilateral cervical lymphadenopathy in a child less than 5 years

Do clinical examination daily to look for cause...like new rashes,eschar Repeat peripheral blood smear by good pathologist Send blood culture, urine culture, igM for typhus,weil felix, esr,2d echo,cxr,usg abdomen Do Covid test Continue monocef...add doxycycline...

Perform blood culture. If it fails do a bone marrow biopsy

Rule out Rheumatic fever .

XRC normal Dengue Ns1 IgM negative

madam go for blood cultur

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urine r/e , crp. add fluoroquinolone cover too.

do crp , esr ,if both raised for Kawasaki,scrub typhus.anyway send blood culture,meanwhile continue antibiotic

give chloramphenicol and ceftriaxone

i think fever is due to hepatosplenomegaly you can do the salmonela antigen, and blood culture. give him inj artesunet stat dose and iv oflox.. i have same case 5 days back i treated with monocef oflox and artesunt

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