Febrile neutropenia and infection in oncology: Case

A previously well five-year-old boy on day ten of induction chemotherapy for acute lymphoblastic leukaemia is brought to the emergency department by his parents with a three-hour history of fever to 39.0 degrees Celsius. He looks pale and is mildly tachycardic but is alert, perfusing well, and in no respiratory distress. He has a central venous line in situ with a clean exit site. His oral mucosa shows grade 2 mucositis. His chest is clear, his abdomen is soft, and his perianal area is unremarkable on inspection. His full blood count shows a haemoglobin of 104 g per litre, a platelet count of 90 times ten to the ninth per litre, and a white cell count of 0.8 times ten to the ninth per litre with 10 per cent segmented neutrophils and no bands, giving an absolute neutrophil count of 0.08 times ten to the ninth per litre. His C-reactive protein is 45 mg per litre and his lactate is 1.8 mmol per litre. He is on co-trimoxazole prophylaxis.