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bulging fontanelle - no meningitis

I have a little girl in my practice who presented with fever and fussiness
at around 8 months of age.  On exam, she had a bulging fontanelle and no
other signs.  She was not toxic appearing.  I did a complete workup on her
and turns out that she had a UTI.  CSF was clear.  The bulging resolved when
her fevers stopped.

She presented again to the ER with fever (103) a few months later and was
again noted to have a bulging fontanelle and no other real signs nor
symptoms.  They called it an ear infection and sent her home on Amox much to
my chagrin.  Not even a urine culture or CBC done.  (Ack!  pediatrics in the
ER - that's another discussion thread...).  Luckily, the bulging resolved
again when she became afebrile.  She saw me in follow-up and looked fine.

I entertained imaging her head but it never happened again and I didn't
pursue a further workup.  Pseudotumor Cerebri?  The bulging wouldn't just
resolve would it?  The fever was just coincidental?  Now I'm wondering if I
should go forward with the CT after all...

Eve Switzer, MD
rural peds