Viral Hemorrhagic Fever - Pediatric Oncall

4th Pediatric Infectious Diseases Conference

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

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	Specialist Answers
Question
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.
Answer
One should rule out conditions such as viral hemorrhagic fever especially dengue since she had myocarditis (ventricular tachycardia), shock (progressive hypotension) and fever and vomiting. Other conditions such as demyelinating disorder with infections should be ruled out. What was her renal function tests and liver functions test? Also was her neurological examination normal? Details about that would be useful. Back to All Questions

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