Question of the Week

Question :
Posted On : 01 Jul 2019
9 months old boy of non-consangous marriage presented with cough since 3 days and 2 attacks of generalized convulsions since 1 day. He had a previous history of cough 2 months back for which he was admitted for 8 days and started on 3 antituberculous drugs and was on the same since then. His birth was uneveniful and was immunized till date. He was on exclusive breast feeds. He is suffering chronic diarrhea. On examination, his vital parameters were normal. He has pallor and hyperpigmented fingers. There were no meningeal signs. Systemic examination revealed hepatosplenomegally and bilateral lung crepitation which worsend inspite of potent antibiotic. His conciousness was impaired but cranial nerves, tone, power and planter reflex were normal.

Investigations showed:
-WBCs=1,900 cumm,platelets=100,000 cumm
-Hb=9.3 gm, dl , reticulocytes=0.8 percent
-ESR=15mm at the end of 1st hour
-CSF normal
-Chest X-ray: bilteral patches
-ALT, AST, serum Ca, random blood glucose, serum electrolytes, blood gases , serum ammonia and urine examination were normal
-HIV , Mantoux test and blood culture were negative
-PT and PTT were normal

What is the diagnosis and Discuss pathogenesis of clinical findings_?
Expert Answer :
This child has encephalopathy with pancytopenia and fluffy shadows on the cest xray. Get his MRI brain done to rule out encephalitis. Also send CSF for cultures - Tb and viral PCR especially Herpes PCR. Also do an EEG and serum ammonia. It looks like a viral infection.
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