Lethargy, Decreased Feeding and Icterus

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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

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Question
A baby boy brought on day 6 of life with lethargy, decreased feeding, icterus. Birth history: born out of non consanguineous marriage by full term lscs wt:2.8 kg rest uneventful.o/e:pallor, pustules over extremities and trunk, icteric till thighs, AF leveled, CRT instant, suck rooting was good,RS CVS:NAD, P/A:distended,soft liver 3cm with tenderness on palpation, spleen just palpable. On admission blood sent for metabolic workup and CBC, CRP,blood culture. He was given 10% dextrose, push started on 10% isolyte-p Maintenance fluid iv taxim,ampoxin & amikacin started double surf p t.feeding tube kept in situ on 3rd day of admission coffeebrown RT aspirates iv cepime fortum added taxim amikacin omitted. given platelet concentrate and packed rbc's once. Investigations as follows:On D1 - Hb 11.1 WBC 13700, P70L28E1M1,PLATELET 1LAC/cmm ,PCV 31,total bili 13.7 indirect 11.9 direct 1.8, crp +ve (1:16dil), blood culture no growth after 72 hours of incubation. On D3- Hb11, wbc14700,p51l32 band forms13% platelet 1.6 lac malarial parasite not seen. csf : 2cells, no rbc's ,csf glucose39.3, protein 18.72 mg%. csf grm stain afb negative. RBS 59.65mg% PT 20sec/control 13sec, aPTT 35 sec/ control 30sec.bili total9.2mg% indirect 8.2mg%. BUN 15.3 CREAT 0.52. On D4 of admission USG abdo: liver homogenous echotexture shows multiple tiny focal hypoechoeic lesions in the right and left lobes. measure 1-2 mm in size and distributed in the periportal region. no cysts seen. biliary radicles & hepatic veins are normal. s/o multiple hepatic abcesses.kidneys normal in size with no cysts seen. Repeat USG after a week of antibiotics showed minimal impovement but multiple tiny hypoechoeic lesions were still present On D10 of admission CT ABDOMEN: multiple ill defined non enhancing lesions predominantly in right lobe of liver in periportal region possibilities are developing abcesses, inflammatory pseudotumor, hemangioendothelioma. On D11 Hb 10.6 PCV 32.8 WBC 17800 P34 L64 B1 M1 PLATELET 1.89 MCV 104.1 MCH 33.7 MCHC 32.2 RBC 3.1 million, RDW 64.2fl baby discharged after 14 days of iv antibiotic with probable diagnosis of late onset sepsis (though not proven by lab tests). my dialema is what were those multiple tiny hypoechoeic lesions periportally in right lobe of liver.
Answer
Since they were suggestive of abscesses one must rule out gram negative infections, congenital tuberculosis and underlying immunodeficiency (primary or secondary). Back to All Questions

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