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

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	Specialist Answers
Question Category : Lymphadenopathy
One day, incidentally I detected that my 4 year old son has lymphadenopathy at posterior triangle, inguinal region. They are discrete, non tender, size < 1cm each. he has seborrhoea at present. Recently he acquired URTI 3 times within 1 month. Otherwise he is alright except under weight since child hood with normal height and intelligence. What should be my next approach? Check Out the Answer
Question Category : Lymphadenopathy
A Child of 4year 4 month old (Dob- 4th july 2004) had neonatal pustulosis which was - treated with antibiotics.< The child had inguinal hernia and emergency surgery was performed at 7 months of age. At the age of 1 yr the child had BCG adenitis, mt+ve, His biopsy revealed langhans giant cell child was given first course of AKT for 6 months, child was apparently ok for the next 7 months. When he was 2 yrs 4 months, he had loose motions, fever, was not not gaining weight, thriving well. Child's barium meal follow up was done which revealed ileal narrowing, he was diagnosed to have abdominal tuberculosis and was again started on AKT for 9 months, and child started gaining weight. He was also thriving well for apparently next 6-7 months. At the age of 2yr 9 months it was radiologically proven that the child had pneumonia with hilar lymphadenopathy and he was given a course of anti biotics for the same ,his chest lesion resolved. The when he became 3 year 2 months he had- high grade fever. Persistent child was treated for enteric and malaria. April 2004 , child came with persistent fever, x-ray chest revealed widened mediastinum, ct chest revealed mediastinal ln, parenchymal lung lesion over left lung base, extending up to pleura, with pleural effusion. multiple small para aortic ln + mt -ve, child was given a course of AKT ( third time 2 sehrz+1ehrz+ 6 hr) which child was still taking till last episode. He gained wt around 1 kg. Bal was done - no AFB, PCR -ve. July-2004 child presented with persistent irritation or urethra, no hematuria but frequency + USG - KUB revealed a thickened post wall of bladder, cystoscopic biopsy was done which did not show any granuloma, but did reveal chronic inflammation with multi layering, polypoidal lesion. AFB-ve, PCR- ve, child was continued on AKT. Child again had persistent fever 2 months later, which subsided with anti pyretics. Child again came to us on 2nd nov, with high grade fever, cough, occ. Loosemotions, heaptsplenomegaly+ no visible lnodes. Ct chest/abdomen revealed the size of ln had gone down significantly, fresh lesion on the rt. Lung base, no abdominal lnodes. This child's all his routine investigations were normal all the time except ESR which was 30 to 50 during all episodes. And hb was around 9-10, culture never grew any organism. This time considering a probability of drug fever all medicines were stopped, but fever still persisted. My impression was a chronic intercurrent infection / inflammation involving reticuloendothelial system without evidence of hypersplenism, with involvement of lung parenchyma and gitract.d/d comes to tb. Primary immune deficiency to be ruled out. Hiv -ve. What is your opinion? Check Out the Answer

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