Pneumonia with hepatitis responding to clindamycin

 
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A 5½ years old boy presented with recurrent fever and jaundice for 1½ months, with right ankle pain for 7 days. He had Widal positive {0 titre= 1:160} and was treated with cefaperazone for 10 days to which fever responded. However again for past 7 days, he had fever, jaundice and ankle pain. On examination, he had jaundice, hepatomegaly and right ankle cellulitis. He had right infra-mammary crepitations. Investigations showed hemoglobin of 8.6 gm, dl. WBC count of 23,200, cumm {81 percent polymorphs, 17 percent lymphocytes} and CRP of 167 mg, dl with ESR of 101 mm at end of 1 hour. Chest X-Ray showed right lower haziness. Liver functions showed bilirubin of 8.9 mg, dl {direct = 2.6 mg, dl}, SGOT of 208 IU, L, SGPT of 100 IU, L and albumin of 2 gm, dl. He was started on Cefotaxime and Cloxacillin for 12 days but fever persisted. Blood culture did not grow any organism. He was started on piperacillin-tazobactum and clindamycin to which fever subsided in next 48 hours and LFT also showed improvement. CRP also decreased to 68 mg, dl.
Expert Opinion :
Thanks for all the wonderful inputs. Yes, the ultimate thoughts on this case was staphylococcus aureus {as child had pneumonia as well cellulitis}. In view of hepatitis, he was thought to have a viral infection additionally.
Sometimes, it is just not possible to get any organism on the culture and one has to go by clinical judgement and use an antibiotic as per suspected antibiotic.
Answer Discussion :
S
Srinivas prasad
bubble
staphylococcus
6 years ago
A
akila devic
bubble
mrsa
6 years ago

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