Facial puffiness, Abdominal Distension and Body Pain

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 13 year old girl presented with complaints of facial puffiness since 3weeks, abdominal distension since 2weeks,weakness and body pain lasting for 6-7 months. There is no history of hematuria or polyuria. There is no h/o breathlesness, chestpain,c ough. There is no h/o jaundice, bleeding manifestations, abdominal pain, diarrhoea, vomitting. There is no h/o tuberculosis in past. o/e there is severe pallor, nolymphadenopathy, no icteruus, anasarca. There is tense ascites and no other significant findings. Investigations revealed: hb 5gm% , tc 12800, dc p 35 l65, e0 m0 esr 70 mm, urine alb ++++, pus full field rbc abs, casts abs se.sugar(r) 87 mg% , se.bili T 0.9 mg% , D 0.2 mg% , AST 34 IU/L ALT 35 IU/L ALK PHOS 133 IU/L S. PROTEIN total 2.0 gm% alb 0.8 gm% urine culture was sterile. Blood culture was sterile. perip. smear showed rbc microcytic,hypochromic,target cells. wbc lymphocytosis. platelets 1.7 lakhs/ retic count 17% SICKLING TEST was positive. USG ABDOMEN reveals normal liver texture, gross ascites and renal parenchyma disease grade 1.ovaries were also normal. Chest XRAY shows b/l pleural effusion and pericardial effusion. patient was given antibiotics and oral prednisolone. Fresh FFP was transfused for 7 days. BT was given for 3 units. Even after 3 weeks of steroid urine alb remains ++++ and ascites remained same. Diagnostic tap revealed. prot. 0.3 gm% glucose 40 mg% cells 5,800/mm3 lymphocytes 100% A D A 1.4 u/L repeated urine cultures sterile. PUS cells remains full field. HIV SCREENING neg. RESPECTED SENIORS, I just want to have your advice regrading how to proceed with the case. There are features of haemolytic anemia(SICKLE CELL),nephrotic syndrome and sterile pyuria. Can we proceed with administration of ATT drugs or go for UROGRAMS OR GO FOR RENAL BIOPSY TO FIND OUT RENAL PATHOLOGY. Yours sincerely, a junior resident in pedia.
Answer
What are the serum creatinine and BUN? Also has hemolytic uremic syndrome been ruled out? The ascitic tap is suggestive of inflammation. Do a cytospin for malignant cells. For positive sickling test, do HbEPP to rule out sickle cell anemia. Since the child has been transfused, the HbePP cannot be done at the present and one may need to do parent's HbEPP to see if they have the thal trait. Back to All Questions

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