Diagnostic Dilemma

Fever and Ileus

Author: Pediatric Oncall
A 22 months old girl presented with fever for 10 days, diarrhea and abdominal distension for 3 days. On examination, she was pale, heart rate was 104/min, capillary refill time (CRT) was < 3 seconds. The abdomen was distended with sluggish bowel sounds. Other systems were normal. X-Ray abdomen showed multiple air fluid levels and serum electrolytes were low (sodium = 129 mg/dl, potassium = 2.8 mg/dl). There was no acidosis. Hemogram showed hemoglobin of 8.4 gm/dl, WBC count of 3,000/cumm (48% polymorphs, 52% lymphocytes), platelet count of 1,18,000/cumm. She was kept nil by mount (NBM) and started on intravenous (IV) Fluids, IV antibiotics, and potassium correction. Her potassium normalized in 24 hours but abdominal distension and sluggish bowel sounds persisted. Subsequently, she developed edema and ascites. Investigations showed:

• Hemoglobin = 8.3 gm/dl
• WBC = 8,300/cumm (70% polymorphs, 30% lymphocytes)
• Platelet = 40,000/cumm
• SGPT = 67 IU/L
• Blood culture = No growth
• Creatinine = 0.7 mg%
• BUN = 11 mg%
• Prothrombin Time = 23.2 sec (prolonged)
• Partial thromboplastin Time = 43.6 sec (prolonged)
• Urine = Normal
• Total proteins = 3.4 gm%, Albumin = 1.8 gm%.

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