Fever for 15 days with one episode of convulsion

 
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A 1 year old girl born of non consanguineous marriage presented with fever and cough for 15 days. She had an episode of generalized tonic clonic convulsion 1 hour ago with frothing from month and lasted for 5 minutes without any past-ictal drowsiness. Father had history of febrile convulsion in his childhood. On examination, child was febrile, had no neck stiffness, had congested and enlarged tonsils. CNS examination, blood pressure was normal. Other systems were normal. A lumbar puncture done showed clear, colorless fluid with normal sugar and proteins with 178 RBCs/hpf and 2 lymphocytes/hpf.
Expert Opinion :
This child has fever since 14 days with tonsillitis, CSF shows RBCs (non-traumatic trap). Hence the diagnosis would be viral meningitis. Even though there is family history of febrile convulsion, the child has had convulsion after 15 days of fever and CSF is not absolutely normal. Thus, diagnosis of atypical febrile convulsion is unlikely.
Answer Discussion :
B
Basir Ahmad
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simple febrile seizure due to tonsillitis.
S
Sayenna Uduman
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An episode of brief generalized convulsion in an year old infant after a long standing 2 week fever of respiratory sources; is a case of ‘febrile seizure’ ; a family history support the genetic component of this A clear non-xanthochromic CSF with normal CSF protein and sugar rules out acute purulent bacterial meningitis despite the 2 lymps seen which is in a higher proportion to the 178 RBC counted . May require repeat LP, if clinically indicated to rule out herpes CNS infection which is unlikely in this child

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