segunda-feira, 2 de novembro de 2009


Title :
Fever with hepatosplenomegaly

Author Details :
Ira ShahMedical Sciences Department, Pediatric Oncall, Mumbai 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

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