Diagnostic Dilemma

Febrile convulsion

Author: Pediatric Oncall
A 3 years girl presented with recurrent fever for 4 months. It started with fever and cough and a convulsion 4 months ago when she was treated with valproic acid and diagnosed as febrile convulsion. She had another episode of convulsion a month later with a fever. Now fever is persistent for the past one month which has progressively increased to 102-103oF each day. She again had an episode of seizure at present which was treated with IV antibiotics and phenytoin. Again no investigations were done and she was diagnosed as atypical febrile convulsion. There is no headache, vomiting, lethargy, or focal neurological deficits. There is no contact with tuberculosis. On examination, she was irritable, had no meningeal signs and systemic examination was normal. Investigations showed:
• Hemoglobin = 9.8 gm%
• WBC count = 18,800/cumm (60% polymorphs, 38% lymphocyte)
• Platelets = Adequate
• PS for MP = Negative
• Mantoux test = Negative
• Chest X-Ray = Normal
• Widal = Negative

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