A 1-year-old girl was admitted to Harlem Hospital, New York, after three days of cough, high fever, and anorexia, which had not responded to penicillin G potassium given by her private physician for bilateral otitis media. She had been healthy since birth and had not been out of the city of New York for the two months preceding her illness. Her mother and sister had neurofibromatosis, and the patient had multiple cafe-au-lait spots. There were no pets in the family's house, but she had played with a neighbor's dog two weeks prior to the illness.
On physical examination the child was lethargic and dehydrated. Her temperature was 39.4 °C. Her throat was injected, and there was mild erythema of both tympanic membranes. Results of examination of the chest and abdomen were unremarkable. A chest roentgenogram was normal. Laboratory data included a WBC count of 20,400/cu mm with 50% polymorphonuclear leukocytes,