Fever and Reduced Appetite - 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
I would like to post my query regarding this case of a Child age 6 years. Presenting to us with a history of fever and reduced appetite for past ten days. She had jaundice for 6 days, pallor for 5 days and increased respiratory movements for past three days before admission respectively. On examination the child was tachypneic with pallor, moderate grade fever, icterus, no lymphadenopathy, mild abdominal distention, tender heaptomegaly extending 5 fingers below SC margin firm margins and smooth surface, B/L equal chest entry. Rest of the systems were within normal limits. On lab investigations:- Hb 6.7gm%, TLC 5000 with a slight polymorphonuclear predominance, S. bilirubin 5.6 direct 3.8, SGPT 377U, platelets 20,000 , GBP confirmed the above findings and no hemoparasite was found neither in the GBP nor in the QBC. Widal was not confirmatory. Total serum proteins were 4.4 gms, S albumin 2 gms. PT was normal. Urine routine microscopy was WNL too. Abdominal USG of the child showed hepatomegaly with mild parenchymal involvement and mild ascites. The child was put on iv ampicillin and iv gentamycin, iv D10% with MVI and inj HEPAMERZ, syp lactulose, inj vit k, ranitidine, oxygen by mask and an urgent fresh whole blood was transfused. The child was 24 hrs. under this treatment when his tachypnea improved slightly but his liver size increased . The fever also was unrelenting. The antibody tests for dengue were also negative. I am in a fix over the diagnosis and further line of treatment. Keeping in mind the tests mentioned above, all suggestions would be welcome.
Answer
What is the reticulocyte count? If it is low, rule out bone marrow involvement and a bone marrow examination would be required. If it is high, a coombs test and G-6 PD deficiency should be ruled out. Also malaria should be ruled out. What is the ESR? A differential of leptospira, malaria should be considered. Also malignancy, hemophagocytosis and autoimmune disorder should be ruled out if infection is negative. Back to All Questions

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