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Diagnostic Dilemma

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Author: Sujit Ranjane

Question
5 years old boy came with not gaining height. He is 2nd issue of 3rd degree consanguineous marriage of Muslim community. First sibling is 8yrs old male with normal height and weight.
Mother gives similar history of slow growth of her height. There is no major illness in past or hospitalization or TB. No congenital anomalies. Birth history-full term child with average birth weight. Child is having spectacles since 3 yrs of age for refractive error, squint and is been treated for right eye amblyopia. He eats a mixed diet and has a reasonable appetite. On examination, weight is 11kg {for expected 18 kg for his age}, height is 90cms with upper segment- lower segment ratio of 1. His head circumference is 49cms and mid parental height is not taken. He has pallor with no abnormal systemic examination. On investigation, his CBC shows dimorphic anemia with high eosinophilic count. ESR, Mantoux test, chest X-ray, liver function tests, renal function tests, thyroid function tests, urine and stool examination are normal. X-ray wrist shows bone age of 3 years.

How to investigate further_?

Answer Discussion :

makramgs nagy