Diagnostic Dilemma


A 6 months old boy presented with progressively increasing swelling on right side of abdomen along with jaundice and clay stools for 1 week. He was detected to have hepatoblastoma at 3 months of age for which he underwent right extended hepatectomy and was on cisplatin. He had also received multiple blood transfusions. On examination, he had hepatosplenomegaly, weight was 5.35 kg. Investigations showed hemoglobin of 11.3 gm, dl, white cell count of 11,800 cells, cumm, platelets of 2,24,000, cumm, bilirubin of 16.8 mg, dl {direct = 6 mg, dl}, SGOT of 42 IU, L, SGPT of 92 IU, L, total proteins of 6.2 gm, dl, Albumin of 3.1 gm, dl, alkaline phosphatase of 1744 IU, L. Ultrasound abdomen showed hypertrophy of left lobe of live with no intrahepatic biliary dilation. MRI abdomen confirmed the findings. HIDA scan showed good extraction but poor biliary drainage. Liver biopsy was suggestive of extrahepatic biliary atresia with cysts of toxoplasma. TORCH litres showed CMV IgM positive, negative IgM toxoplasma {0.28} and equivocal toxoplasma IgG {0.93}.

Is this really toxoplasmosis_?
Expert Opinion :
Review of biopsy from another pathologist was suggestive of recurrence of hepatoblastoma.
Answer Discussion :
Rajeev Malhotra
Yes, IgG titres acquired passively from mother should have vanished.
7 years ago
Dominguez Sampedro
No idea
7 years ago

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