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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
K is a 2.5 year male child presented with history of multiple fractures of different bones at different times (within a span of 6 months).He was well apparently upto 2 yrs of age. At the age of 2 yrs (6 months back) he had trivial trauma, followed by fracture (1st) of left humerus followed by sub acute osteomyelitis which was treated appropriately.2ndfracture was after 1 month gap, right arm bones with radiologically s/o periosteal reaction with F/O osteomyelitis, which needed fixation with screws.3rd was fracture separation of right tibial epiphysis, which was treated with POP cast. At present (4th) he has swelling of left knee with radiological evidence of periosteal reaction. Otherwise apparently the child was normal upto 2 yrs of age. (Birth and developmental history is normal Physical examination revealed swelling of left arm and right knee joint, left arm is covered with cast. No blue sclera, no hearing abnormality, otherwise well and active child.) Investigations revealed normal total count, platelet, differential count, LFT normal, calcium and alkaline phosphatase were also normal, blood culture was found to be sterile. X-rays of affected parts showed perioteal reaction, with fractures of the bone. Bone biopsy showing evidence of new bone formation with marked osteoblastic activity with no significant inflamation. Bone culture was also sterile.MRI done at the time of 2nd fracture was reported as subacute osteomyelitis of left distal humerus and supracondylar fracture of right humerus. Bone scan is showing increased osteoblastic activity involving right humerus and right femur with no definite evidence of bony inflammation. Immunoglobin profile is normal, NBT reduction is also normal. Check Out the Answer
Question Category : Diagnostic Dilemma
An 8 year old boy was presented with 2 episodes of lt knee monoarthritis accompanying exudative tonsilitis in a span of 3 months. Fever settled in 7 days with a course of IV cefuroxime and ibuprofen. The monoarthritis resolved in 4 to 5 days.ESR increased from 70mm on admission to 90mm to 105mm after a week.CBC showed microcytic hypochromic anemia with normal WBC and platelets.Monospot TORCH ASOT ANA and Rheumatoid factor were negative. Xray of left Knee reported soft tissue swelling but normal joint spaces. No L.nodes, rash orhepatosplenomegaly. NOTE :This boy is the sibling with chronic polyarticular JRA on treatment. Check Out the Answer
Question Category : Diagnostic Dilemma
12 years old male presented to the causality complaining of: fever, dry cough, S.O.B and swelling of the left face, neck and upper limb for 7 days PTA. O/E: finger clubbing grade 2, hepato splenomegaly, visible pulsations in the pericordium and supra sternal notch, tachycardia, tachypnea, stony dullness over the lower zones of the chest. Investigations done as follow.. BFFM +ve Hb% 9 gm TWBC 15.000 mainly lymphocytes ESR 115 RFT was normal x-ray shows bilateral pleural effusion (moderate amount) CT scan of the chest shows cystic bronchiectasis and basal bulle.. pleural fluid tap was hemorrhagic and it's analysis shows: protiens : 4.5 g/dl sugar : 56 g/dl cells : lymphocytosis mantoux test was negative.. sputum for acid fast bacilli was negative.. Echocardiography was done and was normal. Rx : patient received I.V ceftrixone and ampiclox for 2 weeks and now he is on Ampiclox and cefixime capsules.. Please help us to reach a spot diagnosis and proper management. Thank you for being patient with us.. Check Out the Answer
Question Category : Diagnostic Dilemma
To Dr. Sarala Rajajee, Kanchi Kamarkoti Child Trust Hospital, Respected Madam, This patient initially came with fever for three days ,he had H/O Epistosis and the patient was admitted. On admission, SpO, Lo, NO glands blood count 21,800 (N65 L31%, platelet count 0.08%. Patient improved with platelet transfusion and IV antibiotic, Monocef, (500mg) IV BD (20.11.5005). The patient present with discharge of blood orally and with stool. The Patient again had fever and convulsion on 08.12.2005, on admitting later malaria vivax was +ve. Blood count was within normal limit, PBS -> no abnormal cell. Platelet count 69,000. This time platelet improved without any transfusion and antimalarial drug was given and the fever subsided within two days (80,000 platelet) and platelet count improved to 2,74,000. Again on the 4th of January the platelet count came down to 1,60,000. Kindly inform me about the subsequent course of treatment. Check Out the Answer
Question Category : Diagnostic Dilemma
How will u approach a 10 years old child who presented with facial puffiness? No history of oliguria/hematuria. BP is normal. Respiratory, CVS,CNS,examination is normal. NO organomegaly. No ascites. CBC, Urine examination, chest Xray, RFTs, Serum proteins was also normal. What is the further line of investigation? Check Out the Answer
Question Category : Diagnostic Dilemma
A 13 year old girl presented with complaints of facial puffiness since 3weeks, abdominal distension since 2weeks,weakness and body pain lasting for 6-7 months. There is no history of hematuria or polyuria. There is no h/o breathlesness, chestpain,c ough. There is no h/o jaundice, bleeding manifestations, abdominal pain, diarrhoea, vomitting. There is no h/o tuberculosis in past. o/e there is severe pallor, nolymphadenopathy, no icteruus, anasarca. There is tense ascites and no other significant findings. Investigations revealed: hb 5gm% , tc 12800, dc p 35 l65, e0 m0 esr 70 mm, urine alb ++++, pus full field rbc abs, casts abs se.sugar(r) 87 mg% , se.bili T 0.9 mg% , D 0.2 mg% , AST 34 IU/L ALT 35 IU/L ALK PHOS 133 IU/L S. PROTEIN total 2.0 gm% alb 0.8 gm% urine culture was sterile. Blood culture was sterile. perip. smear showed rbc microcytic,hypochromic,target cells. wbc lymphocytosis. platelets 1.7 lakhs/ retic count 17% SICKLING TEST was positive. USG ABDOMEN reveals normal liver texture, gross ascites and renal parenchyma disease grade 1.ovaries were also normal. Chest XRAY shows b/l pleural effusion and pericardial effusion. patient was given antibiotics and oral prednisolone. Fresh FFP was transfused for 7 days. BT was given for 3 units. Even after 3 weeks of steroid urine alb remains ++++ and ascites remained same. Diagnostic tap revealed. prot. 0.3 gm% glucose 40 mg% cells 5,800/mm3 lymphocytes 100% A D A 1.4 u/L repeated urine cultures sterile. PUS cells remains full field. HIV SCREENING neg. RESPECTED SENIORS, I just want to have your advice regrading how to proceed with the case. There are features of haemolytic anemia(SICKLE CELL),nephrotic syndrome and sterile pyuria. Can we proceed with administration of ATT drugs or go for UROGRAMS OR GO FOR RENAL BIOPSY TO FIND OUT RENAL PATHOLOGY. Yours sincerely, a junior resident in pedia. Check Out the Answer
Question Category : Diagnostic Dilemma
What would be the most likely diagnosis of a 4 year old child coming with hepatosplemegaly, hand and feet swelling, lethargic, mild anemia, FTT and low albumin with no proteinuria? Check Out the Answer
Question Category : Diagnostic Dilemma
What would be the most likely diagnosis of a child 4 years old coming with hepatospleomegaly, hand and feet swelling, lethargic, mild anemia, FTT and low albumin with no proteinuria? Check Out the Answer
Question Category : Diagnostic Dilemma
What do you think can be the diagnosis for this girl? 12 year old girl came to us with history of fever for 5 days, puffiness for 3 days and poor urine output for a day with lethargy and poor oral intake. On examination the child was pale, had bruises. Temprature 39 degrees, hepatomegaly 2.5cm below costal margin, facial puffiness, pedal edema, ascites. No s/s of failure. LFT- albumin 23g/dl, others normal, hb 7, platelet 100000, TWC 5,000. Urine protein ++, blood+++. The girl also has hypertension, on tab nifedipine and tab captopril. Blood culture and urine culture NG. reticulocytes 0.5, Coombs negative, FBP pending. Check Out the Answer
Question Category : Diagnostic Dilemma
Dear sir, 13 years old male child present with ataxia for one month after falling in bathroom. PMH: known case of medulloblastoma operated on 4 years ago+shunt operation. Then followed by chemotherapy. After the fall, he was referred to his neurosurgeon who arranged CAT scan and told them it is -ve. Do you think any relation between the fall and ataxia? or it is recurrence of the tumor? What is the next step? Check Out the Answer

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