Diagnostic Dilemma

Irritability in a one and a half years old

Author: Pediatric Oncall
A 1½-year-old boy presented with fever, vomiting, and cough for 4 days with irritability. On examination, the child was febrile, had pallor, congested tonsils, and insignificant cervical lymphadenopathy. There were no meningeal signs, focal neurological deficits and reflexes were normal. Other systems are normal. Investigations showed:
• Hemoglobin = 8.4 gm/dl
• WBC = 6,200/cumm (52% polymorphs, 48% lymphocytes)
• Platelet = 2,33,000/cumm
• CSF = Normal
• Chest X-Ray = Normal
• Serum calcium, electrolytes = Normal
• CT brain = Normal

The child was treated with IV antibiotics to which fever and tonsillitis responded. However, his irritability persisted.

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