BackgroundThe initial thought for causes of prolonged fever in children is infection. It is important to get thorough history and clinical examination working towards the correct diagnosis. There is a question of effectiveness of remote consultation (telephone or video) how the correct diagnosis can be made.ObjectivesTo find out the role of remote consultation and delayed diagnosis during COVID 19 pandemicMethodsRetrospective review of hospital case note and GP SystmOne.ResultsA 14 year old girl presented with six days history of high fever without chest or abdominal symptoms. There was no history of recent weight loss apart from initial loss of appetite. The family contacted their family doctor on day three of illness who advised to go to A&E. Her fever started a month prior. She had remote consultation with family doctor five times during this period and she was reassured that could be viral illnesses. COVID test was negative. She was seen in emergency department of DGH was the first time, examined clinically. She had negative urine dip test and COVID test and discharged home with the diagnosis of possible flu like illnesses. She was referred to paediatric assessment by her family doctor 3 days later as ongoing symptoms. She was febrile with significant tachycardia 165 bpm with high blood pressure 160/87 mmHg. There was some abdominal fullness with vague mass in central abdomen. Investigation revealed significantly high inflammatory marker (CRP>200, ESR 120) with anaemia and normal liver and renal function. Ultrasound scan of the abdomen revealed multi-cystic mass, possibly arising from kidney. Subsequently, MRI abdomen confirmed large cystic neoplasm arising from the right kidney. She also had multiple lung nodules and bone lesions on staging assessment CT scan of the chest. She was referred to primary treatment centre and diagnosed with advanced stage renal cell carcinoma. She was started treatment with immunotherapy.ConclusionsOur case is one of the examples of collateral effect of the COVID 19 pandemic. The study from Italy highlighted that number of children diagnosed with cancer was double during the post lockdown period.2 Remote consultation (telemedicine) has quickly established and has positive points such as risk of cross infection and able to get medical advice without increase risk of exposure.4 It is important to remember clinical examination cannot be replaced by remote consultation. The need of guidelines for remote consultation is unquestionable.ReferencesChiaravalli S, Ferrari A, et al. A collateral effect of the COVID-19 pandemic: delayed diagnosis in pediatric solid tumors. Pediatr Blood Cancer 2020 Aug 6:e28640.Graetz D, Agulnik A, et al. Global effect of the COVID-19 pandemic on paediatric cancer care: a cross-sectional study. The Lancet Child & Adolescent Health March 2021.Liu L, Gu J, Shao F, Liang X, et al. Application and preliminary outcomes of remote diagnosis and treatment during the COVID-19 outbreak: retrospective cohort study. JMIR mHealth and uHeealth 2020 - mhealth.jmir.org
Not just simple fever during COVID 19 pandemic