A previously healthy, fully immunized 7-year-old girl presented with a 7-week history of daily fevers and a worsening cough with persistently elevated inflammatory markers. Before admission, she had an unrevealing outpatient workup by infectious disease, rheumatology, pulmonology, and otorhinolaryngology for her fever and other symptoms. Multiple courses of antibiotics had no effect, but brief courses of steroids seemed to modestly alleviate her symptoms. At an outside hospital, a computed tomography neck and chest scan revealed mediastinal lymphadenopathy. She was subsequently transferred to the authors' institution. Her examination was notable for a febrile, tired-appearing girl in respiratory distress with a muffled voice and inspiratory stridor. Her laboratory tests revealed leukocytosis with left shift, microcytic anemia, and hypoalbuminemia, as well as elevated inflammatory markers, ferritin, and fecal calprotectin. Her peripheral smear, uric acid, and lactate dehydrogenase were all within normal limits. Infectious study results, including blood and urine cultures, cytomegalovirus serologies, and Bartonella serologies were negative. On the second read of her outside computed tomography imaging, her lymphadenopathy was felt to be nonpathologic. Based on a recommendation by rheumatology, an ophthalmologic examination was obtained, which revealed bilateral anterior uveitis; however, rheumatologic laboratory test results returned negative. Her fevers continued, and inflammatory markers remained elevated despite antibiotics. On day 6 of hospitalization, she developed worsening respiratory distress, necessitating intubation and transfer to the ICU. Repeat laryngoscopy and bronchoscopy revealed severe purulent tracheitis; however, throat cultures remained sterile. Her clinical deterioration without identification of an offending organism prompted additional evaluation for a systemic etiology.

中文翻译：

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一个 7 岁的孩子持续发烧和咳嗽。

一名既往健康、完全免疫的 7 岁女孩出现了 7 周的每日发烧史和咳嗽加重，炎症标志物持续升高。入院前，她因发烧和其他症状接受了传染病、风湿病、肺病和耳鼻喉科的门诊检查，但未发现任何症状。多个疗程的抗生素没有效果，但短暂的类固醇疗程似乎适度缓解了她的症状。在外面的医院，计算机断层扫描颈部和胸部扫描显示纵隔淋巴结肿大。她随后被转移到提交人的机构。值得注意的是，她的检查发现一名发热、疲倦的女孩出现呼吸窘迫、声音低沉和吸气性喘鸣。她的实验室检查显示白细胞增多伴左移、小红细胞性贫血、和低白蛋白血症，以及炎症标志物、铁蛋白和粪便钙卫蛋白升高。她的外周涂片、尿酸和乳酸脱氢酶均在正常范围内。包括血液和尿液培养、巨细胞病毒血清学和巴尔通体血清学在内的传染性研究结果均为阴性。在对她的外部计算机断层扫描成像进行第二次阅读时，她的淋巴结肿大被认为是非病理性的。根据风湿科的建议，进行了眼科检查，发现双侧前葡萄膜炎；然而，风湿病学实验室检测结果为阴性。尽管使用了抗生素，她的发烧仍在继续，炎症标志物仍然升高。住院第 6 天，她出现呼吸窘迫恶化，需要插管并转入 ICU。重复喉镜和支气管镜检查发现严重的化脓性气管炎；然而，咽喉培养物仍然是无菌的。她的临床恶化没有发现有问题的有机体，这促使她对系统性病因进行了额外的评估。