Diagnostic Dilemma - Pediatric Oncall
TBM with hyperthermia
Author: Pediatric Oncall
A 4 month old girl presented with lethargy, one episode of tonic clonic convulsion and fever for a day. There was no contact with TB. Patient was hospitalized for pneumonia 14 days back for 6 days and was treated with IV antibiotics for 6 days to which she responded. She was born at full term and had birth weight of 3 kg. She was immunized with BCG, and single dose OPV and Hepatitis B. She was on breast feeds. On examination, pulse was 120, min, respiratory rate was 30, min. length was 57 cm, weight was 4.5 kg and head circumference was 38 cm. She had decerebrate posturing, hypertonia, brisk deep tendon reflexes. Anterior fontanelle was not bulging. Other systems were normal. CT brain showed basal exudates and dilated lateral and 3rd ventricle. She was intubated and ventriculoperitoneal shunt was inserted. CSF showed 142 proteins, 160 cells {98 percent lymphocytes and sugar of 22 mg, dl}. Chest X-Ray showed miliary mottling. She was started on 4 drug antituberculous therapy {ATT} along with steroids and leviracetam. Her condition stabilized and patient was extubated after 1 week but fever persisted. After a month of therapy, she had temperature of 107oF at 4.00 am and subsequently died after 12 hours.
Answers of this discussion
Author :- SMITHA RAM on 27 August 2013.
Answer :- hypothalamic dysfunction

Author :- HanumanthaRao K.R on 27 August 2013.
Answer :- cental fever because of TBM and sequele of TB Meningitis

Author :- HanumanthaRao K.R on 28 August 2013.
Answer :- inflammatory response syndrome due to ATT

Author :- Jameela Kahtan on 29 August 2013.
Answer :- This pt may have shunt infection complicated,with brain abcess

Author :- Jameela Kahtan on 29 August 2013.
Answer :- This pt may have shunt infection complicated,with brain abcess

Author :- kamal varshney on 30 August 2013.
Answer :- Pontine hemorrhage

Author :- drnirmala singh on 01 September 2013.
Answer :- MDR TB

Author :- anupama agarwal on 01 September 2013.
Answer :- tubercular meningitis

Author :- Jameela Kahtan on 01 September 2013.
Answer :- vp shunt infection coplicated with brain abcess

Author :- eri rapushi on 01 September 2013.
Answer :- Meningitis

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