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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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Question Category : Diagnostic Dilemma
A baby, 10 year old, presented febrile low grade, marasmic,anemic, distended abdomen, no visceromegaly, chronic constipation, gut sounds audible. What could be the further diagnosis? Check Out the Answer
Question Category : Diagnostic Dilemma
An 8 years old girl, weighing 30Kgs, apparently in a healthy condition, developed low grade fever for 3 days associated with nausea and 3-4 episodes of vomiting. She was advised ofloxacin and domperidone by a local pediatrician. Fever did not reduce by these medications and a repeat advice was sought from the doctor. She was asked to continue the same. On day 3, she started complaining of 'Burning sensation' in feet and wouldn't allow anyone to touch them but she would feel comfortable with application of cold. Her extremities were cold & for this unusual complaint, was taken to a hospital where she was admitted for observations and some IV fluids were administered. Two hours following infusions, she developed agitated behavior.On examination her blood pressure was found to be progressively falling and hence was shifted to ICU. ECG done showed Ventricular tachycardia and despite adequate intervention succumbed to her illness. All her investigations were within normal limits including electrolytes. The patient showed no history of diarrhea, oligouria, any congenital anamolies, birth injuries or cardiac complaints, or previous hospitalization. Check Out the Answer
Question Category : Diagnostic Dilemma
How to differentiate scarlet fever from atypical measles[measles in immunized children]? Check Out the Answer
Question Category : Diagnostic Dilemma
A child presents with dismorphology long phitlum, hypotonia and mental retardation. What are the other syndromes having these feature???? Check Out the Answer
Question Category : Diagnostic Dilemma
14 year old girl has gall stone splenomegaly Hb 7 gm%, Reticulocyte 3.2%, TLC 3,400/cmm, platelet normal, hypochromia (low mch), microcytosis (low mcv), anisocytosis, poikilocytosis, ovalocytosis, RDW is abnormally high, LDH is abnormally high. ESR 45 mm 1st hour. What may be the probable diagnosis? Check Out the Answer
Question Category : Diagnostic Dilemma
A 6 year female child (referred from orthopedics department for ruling out any metabolic disease)presented with progressive left genu valgum since last one year and has a proportionate short stature. There was past history of jaundice 8 months back for 6 days, mild grade undocumented pyrexia on and off (almost once every month) relieved by one day of antipyretics.There is no history of trauma or joint swelling or pain ever in the affected knee and elsewhere, no history of chronic diarrhoea/constipation. On examination it was seen that she had severe pallor,abdominal distention, firm splenomegaly, coarse facies (hemolytic),one cutaneous birth mark (cafe au lait spot).Left genu valgum,compensatory scoliosis,Limblengths are equal,. Blood Investigations revealed pancytopenia, RF positive. PBF-RBCS are normocytic hypochromic,WBCs- no atypical cells. Ophthalmoscopy- no iridocyclitis.USG abdomen- firm 5cm splenoegaly, liver normal,no ascites. Bone marrow- erythroid hyperplasia with dyserythropoiesis. X ray of left kneejoint shows growth arrest lines atlower end of femur and upper end of tibia,no joint destruction,no signs of scurvy or rickets, normal density. Xray spine shows scoliosis. Vertebral bodies are normal-no collapse or beaking. Xray of wrist has 3 carpals and the epiphysis for the lower ends of radius and ulna are also visible. Can this hypersplenism & bony deformity be explained by a single diagnosis? What is the differential diagnosis and the further line of management.? Check Out the Answer
Question Category : Diagnostic Dilemma
4 month baby was admitted with excessive crying which resolved in 2 hours. As a part of investigation x-ray was done which showed cardiomegaly(ct ratio 80%).The Treating physician considered possibility of dilated cardiomyopathy just because of cardiomyopathy after 2 hours of admission patient was asymptomatic. o/e showed no murmur no other significant finding .Then 2D ECHO was done which was absolutely normal. Still the physician insisted that it is dilated cardiomyopathy and started on carvedilol and digoxin. Is it rational? Check Out the Answer
Question Category : Diagnostic Dilemma
A 6 year old child presented to us with complaints of recurrent pyoderma localized to face for 4 years; otitis media for 3 years; crusting from nose for 2 years. On examination it was found that the child has hepatosplenomegaly and generalized lymphadenopathy.All other systemic examination were found to be normal. Investigation revealed normal CBC; XRay and bone marrow. Blood culture was sterile. What could be the diagnostic possibilities? Check Out the Answer
Question Category : Diagnostic Dilemma
A 11 month female infant presented with swelling of left hand & lower end of left forearm. All investigations including color Doppler were normal. After 2 months of onset of this problem, there is slight hypertrophy of left arm. What could be the diagnosis & definitive investigation? Check Out the Answer
Question Category : Diagnostic Dilemma
Dear sir a young couple closely related to each other has a big problem. They have 6 children 3 alive & 3 died due to unknown cause. Those children who died usually had problem at the age 4-6month. They suffered from a chest infection which is resistant to treatment. Those who died were male & female both. The 1st died at 4m, 2nd died at 6m, 3rd died 2year after a protracted course of illness started as LRT infection & lymphadenopathy . The age of the alive children are 8years (female) , 3years(female), 18months(male).The 1st & 3rd are totally normal.The 2nd child ie 3year(female) run the same illness LRT infection , lymphadenopathy, FTT progress to chronic lung disease + clubbing of finger+ chronic exuding ,fascial widespreading skin infection . Those who died & this patient. are fully vaccinated ,while those survived are not vaccinated . On examination chronically ill child was under weight dyspenic with + clubbing of fingers Vital sign are normal apart from tachypenia. Generalized lymphadenopathy, Resp. system: bilateral rhonchi & crepition Cvs. System: normal Soft abdomen, mild hepatosplenomegaly Investigation: CBC was normal GOT+GPT normal. Blood urea & creatinin was normal Immunoglobulin assay showed normal ESR 50. Sweat test was normal Toxoplasmosis titer: -ve Blood , urine, stool culture are Ã¢â?¬â??ve Tt reaction Ã¢â?¬â??ve ACE normal Sputum for Tb bacilli Ã¢â?¬â??ve Gastric aspirate for Tb bacilli Ã¢â?¬â??ve Bone scan was normal. Abdominal sonar was normal Cxr & CAT scan chest infection & hilar lymphadenopathy +lung fibrosis. Lymph node & lung biopsy :Follcular hyperplastic lymphadenitis with evidence of progressive transformation of germinal centers & occasional mini clusters of epitheloid & giant cells without true granuloma formation or caseation necrosis. This is most consistent with: a. progressive transformation of germinal centers. b. Toxoplasmosis & other specific(none-Tb) infection. The skin lesion as seen by an expert dermatologist to be mostly as Tb of skin. What is your opinion about this case? Waiting your advice. Check Out the Answer
Question Category : Diagnostic Dilemma
The last time i asked pediatric oncall a question on leukodystrophy it was answered very generally. It lacked the personal touch and my query wasn't satisfied. I again have a patient whom we think to be a certain leukodystrophy?? MRI was postponed due to delay in arranging funds by the family. The sequence of findings is as follows- Male child who is 14 yrs of age. Presenting with difficulty in walking, speech and abnormal behavior since last 4 yrs, with increased tone in all the four limbs. His mother confirms increased skin pigmentation along with the problems started. Our first doubt was ALD. But family also has an elder FEMALE sibling who had similar problems starting around the same age with increased pigmentation and is presently 18 yrs old. CECT in this boy is suggestive of hypodensities in both cerebral hemispheres and basal ganglia (CECT done outside). Now can you please suggest some disorder which encompasses both the siblings? Please help me at the earliest. Check Out the Answer

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