Diagnostic Dilemma - Pediatric Oncall
Author: Pediatric Oncall
A 4 years old boy presented with jaundice, ascitis, hepatomegaly and multiple abscesses over sternum and back for which he was on antituberculous therapy {ATT} for past 1 month. He was treated for tuberculosis {TB} at 1 year of age for 5 months in view of fever. At 2½ years of age, he had multiple abscesses over neck, sternum, back, left thumb. At 3 years, sternum abscess was drained and he was again given ATT for 7 months. At 3½ years of age, he had icterus and ascitis. There is no contact with a patient suffering from TB. On examination, height was 82 cm, weight was 13 kg and he had pallor, clubbing, a draining sinus over cervical region and sternum with hepatosplenomegaly and ascitis. On respiratory system, he had bilateral crepts. Other systems were normal. His CT chest showed osteolytic lesion in sternum with pericardial effusion, consolidation in left lower lobe of lung and right paravertebral abscess. Ascitic fluid did not grow any MTB after 6 weeks nor did the sternal pus. He was put on category 2 of ATT.
Answers of this discussion
Author :- jyoti sharma on 15 October 2012.
Answer :- Class 1 Histocytosis{Langerhans`cell histocytosis}

Author :- Hany EGYcas on 15 October 2012.
Answer :- possible imune deficency disorder like x web addressed bruton disease

Author :- amlcash adv on 16 October 2012.
Answer :- imunodiffecency

Author :- Hesham Omar on 17 October 2012.
Answer :- yes it is

Author :- armagan ozturk on 17 October 2012.
Answer :- may be it is secondary infection like actinomycosis...

Author :- khurram shahnawaz on 17 October 2012.
Answer :- i think we should consider immunodeficiency in this child. male with multiple recurrent abscesses...i would like to consider CGD{chrnic granulomatous disease}. we should go for NBT test followed by cytochrome c reduction

Author :- Abhay Rathod on 17 October 2012.
Answer :- IMMUNODEFICIENCY _?_?_?_?_?_?

Author :- sree harsha on 18 October 2012.
Answer :- work up for primary immunodeficiency disorder- phagocytic cell disorder

Author :- Pediatric Oncall on 18 October 2012.
Answer :- All of you have recommended ruling out an immunodeficiency. What workup for immunodeficiency would you recommend for recurrent abscess or recurrent TB_? Do you think it is Brutons agammaglobulinemia_? Would it only cause abscesses or would the child have other infections too_? What would be the diagnosis for the same_?

Author :- mehernosh asli on 20 October 2012.
Answer :- Multi-drug resistant TB is one possibility.Also X-web addressed agammaglobulinemia.

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