GRAND ROUNDS AND TEACHING FILES
Fever, Pancytopenia, Hepatitis


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Clinical Problem:


Ira Shah
Medical Sciences Department, Pediatric Oncall, Mumbai, India

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056


A 2 months old boy born of non-consanguineous marriage presented with fever for a week. There was no cough, vomiting, convulsions or bowel complaints. He was 3rd of 3 siblings. First child had died due to fever and anemia at one and a half months of age. Second child was alive and well. The patient was born full term without any complications and pregnancy was uneventful. He was on exclusive breast feeds. On examination, the child had hepatosplenomegaly and anemia. Other examination findings were normal. On investigation:
• Hemoglobin = 3.8 gm, dl, WBC = 3,300, cumm, Platelets = 82,000, cumm
• Reticulocyte count = 1-2 percent
• Bilirubin = 0.9 mg, dl, SGOT = 240 IU, L, SGPT = 320 IU, L, Total proteins = 6 gm percent,
Albumin = 3.2 gm percent
• Renal function tests, serum electrolytes = Normal
• Chest X-Ray = Normal
• USG Abdomen = Hepatosplenomegaly
• Blood culture = No growth
• Urine and stool examination = Normal
• TORCH titres = Elevated CMV IgG. Rest all normal
• Fundus examination = Normal
• HIV ELISA, VDRL, Parvovirus IgM = Negative
• OptiMAL for malaria and dengue IgM = Negative
• CMV PCR = Negative




What is the diagnosis_?

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