Diagnostic Dilemma - Pediatric Oncall
Liver abscess
Author: Pediatric Oncall
Case Report: - A 7 year old girl born of non consanguineous marriage presented with fever for 1 week and anorexia and weight loss for 3 months. She was on Antituberculous Therapy {ATT} since 3 months in view of Chest X-Ray suggestive of Miliary TB with positive Mantoux test. However drugs had been stopped for past 10 days due to epigastric pain and tingling numbness. There is no contact with Tuberculosis. On examination, she was malnourished {weight = 12 kg., height = 108 cm}, had hepatomegaly with bilateral crepitations. Other systems were normal. Investigations showed:

• Chest X-Ray = Right lower zone pneumonia and small pneumothorax
• Liver enzymes = Twice elevation
• CT Chest – Multiple cystic lesions ranging from 5 mm to 10 mm noted in bilateral lung fields with pneumonia on right side and multiple small abscesses seen in both lobes of liver
• Hemoglobin = 11.5 gm, dl, WBC count = 18,700, cumm {polymorphs = 84 percent, lymphocytes = 15 percent}
• ESR = 108 mm at end of 1 hour
• HIV ELISA = Negative
• GL for AFB = Negative

Child was shifted to 2 drugs ATT.

Answers of this discussion
Author :- Viveksharma on 26 November 2012.
Answer :- disseminated koch`s

Author :- Liubov Nikonets on 27 November 2012.
Answer :- Chronic granulomatous deaseas

Author :- fathalrahman baabeker on 29 November 2012.
Answer :- dissem{nated koch

Author :- pawan parihar on 30 November 2012.
Answer :- tuberculosis,cavitary , multi organ type

Author :- VIVEK PRAKASH on 30 November 2012.
Answer :- mdr tuberculosis

Author :- D Manjunath on 01 December 2012.

Author :- MahfuzurRahman Shaheen on 06 December 2012.
Answer :- disseminated TB

Author :- fouzia alic on 07 December 2012.
Answer :- disseminated tb

Author :- shaukat panjawani on 07 December 2012.

Author :- jagdishkoti on 10 December 2012.
Answer :- In view of no contact history and not responding to att for 3 month ,mdr tb is unlikely think of other dd lile primery imunodeficency or ifpossible diagnotic tap for abess and its analysis for tb histoplasis fungal etc

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