Pyrexia - Pediatric Oncall

4th Pediatric Infectious Diseases Conference

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question
11 year old girl came with complain of pyrexia of unknown origin, pain in abdomen, vomiting. Lab test for malarial parasite, Mantoux, CSF, Chest-xray, USG abdomen - all reports were negative, her initial diagnosis was enteric fever as Widal was mildly positive {1:20,1:60} & Leucocyte count was 3000. Thats why Monocef was given for 1wk. But no response, treatment for malaria was given suspecting Falciparum malaria as anemia was continuously increasing. Again no response. After repeating all the tests, USG Abdomen showed mild ascites, splenohepatomegaly, lymphadenopathy. At this level, her CNS is involved & she was neither opening her eyes nor responding to talk even not for micturation reflex, {responding only for pain}, her CT scan shows mild widening of cortical sulci, 2 Echo shows mild left ventricular hypertrophy, {2pind PCV is given}. Now her ANA was done which is positive {4.38}. Now, patient is well. No fever no vomiting, responding for talk, what to do further????
Answer
Rule out autoimmune disorder (SLE, Systemic onset JIA), malignancy, TB and HIV. If anemia is persistent and ongoing, do a bone marrow examination. Also with CNS involvement, liver and bone marrow involvement rule out Macrophage Activation Syndrome. In MAS, serum ferritin should be very high and bone marrow may show presence of hemophagocytes. MAS may be fatal and methyl prednisolone should be given to break the cycle. Back to All Questions

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