Diagnostic Dilemma

Febrile convulsion

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

Is this febrile convulsion?
Expert Opinion :
This child has been having fever on and off for the past 4 months with now continuous fever for the past 1 month. During those episodes of fever, she has had 2 episodes of convulsion which were labeled as febrile convulsion. Before diagnosing febrile convulsion (which is a diagnosis of exclusion), it is necessary to rule out other causes of fever and convulsion such as meningitis, brain abscess, and SOL. In this child, lumbar puncture showed 64 cells (10% polymorphs, 90% lymphocytes with normal sugar and protein suggestive of partially treated meningitis. Her CT brain was normal. Thus, this child had meningitis which was mistaken as febrile convulsion. The lesson is that every convulsion with persistent fever may warrant a CSF examination to rule out meningitis as one may miss the same clinically which may be detrimental in the long run.
Answer Discussion :
this is not a case of febrile convulsion as 2nd time fever is persistent and convulsion occurs in late phase. Hb reduced poly high but not mentioned about monocytes eosinophil and platelet count which are very important in interpretation of CBC.I think Lumber puncture will give some clues in this case.
1 year ago
Shobitha Bushan
atypical febrile convulsion
1 year ago

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