ISSN - 0973-0958
https://www.pediatriconcall.com/Journal/images/journal_cover.jpg
   
 
Fever with hepatosplenomegaly
Fever with hepatosplenomegaly 26/05/2009 https://www.pediatriconcall.com/Journal/images/journal_cover.jpg
Dr Ira Shah.
Medical Sciences Department, Pediatric Oncall, Mumbai.

Cite this article  Copy Citation
Shah I. Fever with hepatosplenomegaly. Pediatr Oncall J. 2008;5: 145.

Address for Correspondence
Dr Ira Shah, Medical Sciences Department, Pediatric Oncall, 1, B Saguna, 271, B St. Francis Road, Vile Parle {W}, Mumbai 400056.

Clinical Problem :
A 2½ years old girl presents with evening rise of fever since 2 months. She has been treated for the same by antimalarials and oral antibiotics to no relief. There is no cough, vomiting or bladder, bowel complaint. There is no history of contact with adult with TB. On examination, her vital parameters are normal and she has pallor with periorbital puffiness. On systemic examination, she has hepatosplenomegaly. Her baseline investigations were:-
- Hemoglobin = 7.2 gm, dl {MCV = 62 fl, MCH = 18.1 pg}
- WBC count = 8,400 {54 percent polymorphs, 43 percent lymphocytes}
- Platelet count = 2,48,000, cumm
- ESR = 12 mm
- X-Ray Chest = Normal
- Mantoux test = Negative
- Urine = Normal
- HIV = Negative
- USG Abdomen = Hepatosplenomegaly.
 
Question :
How should this child be investigated further_?
 
Expert Opinion :
This child has fever with hepatosplenomegaly. Thus one must consider infective causes such as malaria, leptospirosis, enteric fever, kalaazar, dengue, HIV, TB and Urine infections. Also autoimmune disorders such as systemic onset JIA and malignancy should be ruled out. Of the infective disorders, HIV, TB, Malaria and urine infections have been ruled out in the child. Leptospirosis would lead to multisystem disease if persistent for 2 months and dengue does not lead to fever for 2 months. Thus one must rule out enteric fever in this child. The child’s ESR is normal and thus autoimmune disorders and malignancy seem unlikely. Thus one must do a Widal test in this child. The Widal test was positive with titres of 1:240 for both H and O. The child was treated with IV Ceftriaxone with which the fever responded.

E-published: November 2008 Vol 5 Issue 11 Art No. 47
 
Funding:  None  
 
Conflict of Interest: None
 
DOI No. : 
 
Cite this article as :
Shah I. Fever with hepatosplenomegaly. Pediatr Oncall J. 2008;5: 145.
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0