A tale of two sisters.

摘要

A 4-year-old previously healthy African-American girl was brought to a rural hospital emergency department ED with the acute onset of fever, vomiting, somnolence, and seizures. She seemed in her usual state of good health until she was found outside, by her father, near the family's barn where she had been playing. She was lying unconscious with generalized tonic-clonic movements. According to emergency medical services personnel, she had vomited "a few times" and had been incontinent of urine at the scene, although she was no longer seizing. Upon arrival in the ED, the child was obtunded and ill-appearing and exhibited labored respirations. Her vital signs included a rectal temperature of 39.5癈; heart rate, 78 beats per minute; respiratory rate, 38 breaths per minute; blood pressure, 110/65 mm Hg; and hemoglobin oxygen saturation, 93%. Her pupils were 1 to 2 mm in diameter and sluggishly reactive.