Diagnostic Dilemma

Is it Wiskott Aldrich Syndrome_?

A 6 years old boy presented with fever for 2 months and cough for 15 days. He had been treated for abdominal TB 2 years ago for 9 months. On examination, his weight was 16 kg. Other systems were normal. Hemogram showed hemoglobin of 10.3 gm, dl, WBC count of 9,600, cumm {40 percent polymorphs, 46 percent lymphocytes, 14 percent eosinophils} and platelets of 26,000, cumm. His Chest X-Ray showed bilateral basal and right perihilar haziness. CT chest showed multiple tiny nodular opacities in bilateral lung parenchyma with multiple small cavities in right upper lobe and hilar adenopathy suggestive of tuberculosis. His HIV ELISA was negative. He was started on 4 drug antituberculous therapy {ATT}. Two months later, his Chest X-Ray was normal but thrombocytopenia persisted. He was shifted to 2 drugs ATT. At end of 3 months, he developed atopic dermatitis with seborrheic dermatitis which responded to antihistamines and emollients. He was suspected to have Wiskott Aldrich syndrome {WAS} but MPV was decreased and bone marrow showed increased megakaryocytes. His serum immunoglobulins were also normal. At end of 6 months, ATT was stopped but platelets were still low. He then had malena which required platelet transfusion. His serum IgE was elevated {542 IU, L}.

Is this WAS or is it ITP_?
Expert Opinion :
WAS would have been associated low IgG and IgM which was not the case. MPV is low in WAS.

This child underwent bone marrow aspiration and biopsy and it showed large megakaryocytes.

Is it ITP or WAS_?
Answer Discussion :
sarif malik
12 years ago
namdev birajdar
in mpv ITP is increased.looks like WAS.....WITH PARASITIC INFECTION
12 years ago

View More Comments

Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0