13 year old boy with fever and swelling over the neck

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I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan. 

A 13 year old boy who is a resident of ramannapet.

Chief complaints:- 

He came to the casualty with a chief complaints of swelling over the neck since 10 days a fever with chills since 5 days .

HOPI :- 

Patient was apparently asymptomatic 10 days back then he developed swelling over his neck on right side which is progressive in nature  and  is painfull and after 5 days he got fever   then they went to local children hospital for which they gave medication and the pain resolved but swelling and fever where persistent .

There is a history of headache, loss of appetite.

History of vomiting on taking feed.

No history of malaise, sore throat weight loss.

 Swelling on neck:- 

Daily routine:-

During lockdown he used to play with his pet cat daily. Before 22 days he went to hostel for the first time after 10 days he came back to home after that he started  playing again with his pet and after 1-2 days started developing symptoms.

Scratch marks:-

Past history:- 

no similar complaints are seen in the past .

No history of DM , HTN , epilepsy, CKD , CAD

Personal history:- 

Diet :- mixed

Appetite:- decreased appetite

Sleep:- adequate

Bowel and bladder :- regular

Addictions:- Nil

Family history:- 

not significant

General examination:- 

Patient was conscious, coherent and co-operative and well orientated towards time ,place and person.

Vitals :-

Temperature :- 103 F

PR :- 90 bpm

BP :- 100/60 mm Hg

RR :- 18 cpm

Systemic examination:-

CVS - S1 , S2 heard , no murmur

RS - B/L air entry 

P/A - soft , non tenderness

CNS - NAD

Investigations:-

Abnormal laboratory Parameters:-

Chloride :- 96 mEq/L

Hb :- 12.1gm/dl

PCV :- 34

MCV :- 78.3

MCHC :- 35.6

RBC :- 4.34 million/cumm

Albumin - ++ ( 2.3 gm /dl )

Total bilirubin- 1.3

Direct bilirubin- 0.22

Fever chart :- 

CBP:- 

CUE:- 

Serum electrolytes:-

LFT :- 

ECG:- 

2d echo :- 

Daily laboratory parameters:- 

Current treatment:-

1.Inj PCM 450 mg /IV in 100 ml NS /IV/SOS if temp > 102 degree F
2.IV Fluids - NS and RL @ 100ml/hr
3. Tab . Doxycycline 100mg PO/BD
4. Tab. Azithromycin 500 mg PO/OD
5. Tab. Dolo 500 mg PO / TID
6. Tab. PAN 20 mg PO / OD
7. Plenty of oral fluids
8. BP/PR/Temp charting
9. Tepid sponging SOS
10. Strict I/O monitoring