Diagnostic Dilemma - Pediatric Oncall
Author: Pediatric Oncall
An 8 years old girl presented with recurrent fever for past 1 month. She had an exanthematous rash 2 months ago along with fever that subsided in 3 days. Now she has fever with chills and rigors for one week. There is no cough, vomiting, bladder or bowel complaints. On examination, she had soft hepatomegaly. Other systems were normal. Investigations showed:

• Hemoglobin = 11.4 gm, dl
• WBC count = 6,900, cumm
• Platelet count = 3,52,000, cumm
• ESR = 40 mm at end of 1 hour
• Urine routine and culture = Negative
• Liver function tests = Normal
• S. creatinine = 0.8 mg, dl
• Widal test = Negative
• Stool = Normal
• USG Abdomen = Bilateral pleural effusion with ascitis and gall bladder wall thickening.
• Dengue IgM = 1.55 AI { More than 1.1 = Positive}, Dengue IgG = Negative
• OptiMAL for malaria = Negative

She was treated with ceftriaxone and Amikacin for 7 days to which fever responded.
Answer Discussion :
Enteric fever
2 years ago
anil ram
no. recurrent fever and one month duration rules out dengue
2 years ago
Harshal khunkar
no.because she has no hemorrhagic rash now
2 years ago
Maggie Ho
not really
2 years ago
Dr Indu Kori
she definitely has dengue. .. doesn`t need 2 antibiotics ..I guess any basic antibiotic could also do d needful. for eg CP
the USG findings are quite typical of dengue what we see in our set up too

2 years ago
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