Diagnostic Dilemma


Author: Pediatric Oncall
A one year old boy presented with cough and fever for 7 days. There was no TB contact. On examination, his weight was 7.7kg. He had respiratory distress with cardiomegaly and bilateral pleural effusion. Chest X-Ray showing bilateral pleural effusion with pericardial effusion. Echocardiography showed cardiac tamponade and child required pericardial fluid drainage with ICD insertion in both pleural spaces and anterior and posterior pericardial drain. Pericardial fluid showed raised ADA levels and child was thus started on antituberculous therapy (ATT). However pus culture grew pseudomonas and candida that was treated with antibiotics and antifungals.

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