Liver abscess

 
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Case Report: - A 7 year old girl born of non consanguineous marriage presented with fever for 1 week and anorexia and weight loss for 3 months. She was on Antituberculous Therapy {ATT} since 3 months in view of Chest X-Ray suggestive of Miliary TB with positive Mantoux test. However drugs had been stopped for past 10 days due to epigastric pain and tingling numbness. There is no contact with Tuberculosis. On examination, she was malnourished {weight = 12 kg., height = 108 cm}, had hepatomegaly with bilateral crepitations. Other systems were normal. Investigations showed:

• Chest X-Ray = Right lower zone pneumonia and small pneumothorax
• Liver enzymes = Twice elevation
• CT Chest – Multiple cystic lesions ranging from 5 mm to 10 mm noted in bilateral lung fields with pneumonia on right side and multiple small abscesses seen in both lobes of liver
• Hemoglobin = 11.5 gm, dl, WBC count = 18,700, cumm {polymorphs = 84 percent, lymphocytes = 15 percent}
• ESR = 108 mm at end of 1 hour
• HIV ELISA = Negative
• GL for AFB = Negative

Child was shifted to 2 drugs ATT.

Expert Opinion :
As most of you have suggested, it could still be TB. Thus she is continued on anti TB treatment and is asymptomatic at the moment but continues to have small abscesses in the liver.
Answer Discussion :
M
Mohamed sadhiq ali
bubble
disseminated tb with vit.B6 defi
4 years ago
A
Azeem Walele
bubble
This is not TB. Mantoux is a red herring as she is 7 years old. I would look for other chronic granulomatous causes.
4 years ago

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EAP 2017
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