Persistent Fever, Progressive Cytopenias, and Multisystem Involvement Mimicking Severe Sepsis in An Adolescent: a Case Report

Abstract

Introduction: Persistent fever with progressive cytopenias and multisystem involvement may mimic severe infection and create diagnostic challenges in adolescents. Objective: To describe the clinical presentation and diagnostic challenges of an adolescent with persistent fever and progressive multisystem involvement. Case Report: A 15-year-old girl presented with persistent fever following bilateral leg pain and swelling, followed by progressive anemia, severe thrombocytopenia, hepatomegaly, ascites, hypoalbuminemia, alopecia, and rash. Laboratory findings showed leukocytosis, elevated inflammatory markers, increased D-dimer, and progressive cytopenias, while blood cultures were negative. Despite broad-spectrum antibiotics, transfusions, and supportive therapy, the patient remained febrile and was referred to a tertiary hospital. Result and Discussion: Sepsis and disseminated intravascular coagulation were initially diagnosed, with hemophagocytic lymphohistiocytosis and macrophage activation syndrome considered as differential diagnoses. Further evaluation resulted in a diagnosis of Multisystem Inflammatory Syndrome in Children. Conclusions: Persistent fever with progressive cytopenias and multisystem involvement despite antimicrobial therapy should prompt consideration of hyperinflammatory disorders and early referral.