A Female Child with Recurrent Pneumonia and Webbing of Neck
Senthil Kumar Palaniappan, Thiyagarajan Srinivasan
Department of Pediatrics, Masonic Medical Centre for Children, Coimbatore, Tamilnadu, India
Address for Correspondence: Dr. Senthil Kumar Palaniappan, Consultant Pediatrician, Masonic Medical Centre for Children, Coimbatore-641018, Tamilnadu, India. Email: drvpsk@rediffmail.com
Keywords: Sex Chromosome, Aneuploidy, Trisomy X
Clinical Problem:
A 4 years old female child was admitted with hurried breathing for one day, fever with cough and cold for three days. She was admitted thrice previously for pneumonia elsewhere. She underwent closure of patent ductus arteriosus (PDA) at 1year 6 months of age. She was born by lower segment cesarean section to non-consanguineous parents and had birth weight of 3 kg. Developmental history was normal. She received immunization as per universal immunization programme. On examination, she was sick looking with respiratory distress. Her heart rate was 152/min, respiratory rate was 62/min, oxygen saturation was 95% at room air. She had left convergent squint with webbing of neck (Figure 1). She had intercostal and subcostal retractions with bilateral crepitations on auscultation. Chest X-ray showed bilateral patchy infiltrates suggesting bronchopneumonia. Complete blood counts showed total white blood cell (WBC) count of 10940 cells/cumm with polymorphs 77% and lymphocytes 23%. C-reactive protein was 68.5 mgs/L. PCR for H1N1 influenza virus by throat swab was negative. Sputum was negative for acid fast bacilli (AFB) on smear and GeneXpert for mycobacterium tuberculosis (MTB) was also negative. She was treated with nasal oxygen, intravenous (IV) antibiotics (ceftriaxone, vancomycin), oral azithromycin and IV fluids to which she responded. Her immunoglobulin profile (IgG: 936mg/dl, IgE: 67 IU/ml, IgM: 123mg/dl, IgA: 43mg/dl) and nitro blue tetrazolium (NBT) assay (NBT positive cells: 96%) were normal. Karyotype is depicted in figure 2.
Figure 2. Karyotype of the patient
Figure 1. Webbing of neck
A
Acute Donath-Landsteiner Hemolytic Anaemia (DL-HA) in a 5-year old male child - How to treat?
Gautam Araya
A 5-year-old male present to the emergency department with fever for 8 days and acute onset of dark coloured urine. There was no bleeding from any other site. Five days ago, he was prescribed amoxicil....
|
D
Differential Diagnostic Challenges During the Covid-19 Pandemic for Pediatricians in an Eastern European Country
Szofia Hajósi-Kalcakosz, Borbála Zsigmond, Andrea Párniczky, Réka Bodnár
A two-year-old girl was admitted to a local hospital in Hungary in March 2020 with fever, difficulty in breathing and one week history of coughing. She had chronic cough, frequent respiratory illnesse....
|
S
Serologic Rebound in Congenital Toxoplasmosis
Beatriz Simões Vala, Vânia Leitão Martins, João Patrício de Sousa e Alvim Bismarck do Agro
A male newborn who was the third child of a non-consanguineous couple was referred for further management on the fourth day of life. Asymptomatic toxoplasmosis seroconversion was detected at 21st....
|
A
Acute encephalopathy: What to suspect and how to prevent?
Vinod Kumar Gupta, Vanita Verma, RK Yadav, Mukesh Vir Singh, Anubha Shrivastava
A 9-year-old girl presented with convulsions followed by unconsciousness. She had fever and cough for one week. On examination, Glasgow coma score (GCS) was 8/15. There were no meningeal signs or foca....
|
D
Desquamating Rash with Hepatitis
Parminder Kaur, Vipul Gupta, Reena Jain, Shivanjali Sood
A seven-year-old female child presented with fever for 3 days, oral ulcers and rash all over the body for one day. She was on sodium valproate at 20 mg/kg/day since a month in view of focal seizures. ....
|