Diagnostic Dilemma


Author: Pediatric Oncall
A 3 year old girl presented with fever for 1 month, cough since 15 days and vomiting for a day. There was no urinary or bowel complaints. She was treated with antibiotics and antimalarials for the same but had no response. There was no contact with tuberculosis. Previously she had a febrile convulsion at the age of 1½ years. On examination, she was febrile, had pallor, with multiple cervical adenopathy (largest 1 cm) and a soft hepatomegaly. Other systems were normal. Investigations showed:
• Hemoglobin = 4 gm/dl
• WBC count = 4,700/cumm (80% polymorphs, 20% lymphocytes)
• Platelet count = 1,36,000/cumm
Her CBC improved in 3 days
• ESR = 14/mm
• Reticulocyte count = 0.4%
• Widal = Negative
• RA factor, HIV ELISA = Negative
• Peripheral smear = Dimorphic anemia
• Urine culture, blood culture = No growth
• Urine routine = Normal
• Paul Bunnel test = Negative
• USG Abdomen = Normal
• Stool = Normal
• Chest X-Ray = Normal
• Liver and renal function tests = Normal
• Mantoux test = Negative
• Blood culture = no growth

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