Fever in the Immunocompromised Child

A new fever in a child with cancer, a transplant, primary immunodeficiency, or immunosuppressive treatment changes the usual sequence of care. The first question is not where the fever came from; it is whether the child is already showing impaired perfusion, respiratory compromise, or another sign of sepsis. At the same time, the clinician identifies the degree and expected duration of neutropenia, obtains cultures, and arranges empiric coverage when risk is high. A normal-looking child can still have bloodstream infection because neutrophil depletion limits the inflammatory response. This lesson follows the practical sequence: recognise risk, investigate efficiently, treat on time, and escalate when the trajectory is unsafe.