Diagnostic Dilemma - Pediatric Oncall
Liver abscess
Author: Pediatric Oncall
Question
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.

Expert Opinion :
As most of you have suggested, it could still be TB. Thus she is continued on anti TB treatment and is asymptomatic at the moment but continues to have small abscesses in the liver.
Answer Discussion :
M
Mohamed sadhiq ali
disseminated tb with vit.B6 defi
4 years ago
A
Azeem Walele
This is not TB. Mantoux is a red herring as she is 7 years old. I would look for other chronic granulomatous causes.
4 years ago
M
Mehmet Davutoglu
Milier tuberculosis
4 years ago
M
Mustafa Aydin
Disseminated TBC
4 years ago
D
Dr prakash nagar
Secondary infection with Staph in a child who is immunocompromised and having miliary tuberculosis. Fungal infection may mimic miliary tuberculosis on x-ray so need to review the primary diagnosis.
4 years ago
1234
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.