Pediatric Oncall
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Diagnostic Dilemma  →   Dysmorphism
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Fever with desquamation
Pediatric Oncall
A one-year-old girl with fever for 15 days and diarrhea, vomiting, and maculopapular erythematous rash over the body 12 days ago. She was admitted to a hospital and treated with IV antibiotics but fev....
I
Is this visceral leishmaniasis or autoimmune hepatitis?
Pediatric Oncall
A 10-year-old girl born of non-consanguineous marriage resident of Bihar, India presented with fever and recurrent jaundice for 4 years. She has fever and jaundice every 15 days that lasted 2-3 months....
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A 12 years old with polyarthritis
Pediatric Oncall
A 12-year-old boy presented with difficulty in walking for 6 months and fever and multiple joint swellings for 25 days. He had intermittent hip pain and knee pain. Now, for 25 days, he had swelling in....
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JIA or reactive arthritis
Pediatric Oncall
A 10-year-old boy presented with recurrent joint pain and swelling for 7 years. It started with left knee swelling at the age of 3 years apparently precipitated by a fall. The swelling persisted for 1....
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Irritability in a one and a half years old
Pediatric Oncall
A 1½-year-old boy presented with fever, vomiting, and cough for 4 days with irritability. On examination, the child was febrile, had pallor, congested tonsils, and insignificant cervical lymphadenopat....
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Hepatosplenomegaly
Pediatric Oncall
A 3-year-old born of non-consanguineous marriage presented with progressive abdominal distension after 4 months of age. There was no bleeding, seizures, or jaundice. They consulted a physician for the....
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Imperforate anus
Pediatric Oncall
A 16-month-old boy with an imperforate anus had undergone a right transverse colostomy for the same and was referred for further management. He was born full-term by normal vaginal delivery with no pr....
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Hyperkalemia in a 2 months old
Pediatric Oncall
A 2 months old boy born of non-consanguineous marriage presented with difficulty in feeding with a suck-rest suck cycle for 1 month and excessive crying for 15 days. He had sweating over his forehead.....
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Treatment of hypercalcemia
Pediatric Oncall
A 9-month-old boy born of non-consanguineous marriage presented with polyuria and polydipsia for 1 month. The child had no other problems in the past and had been treated with Vitamin D 600,000 units ....
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Recurrent apnea
Pediatric Oncall
A 1½-month-old boy born of non-consanguineous marriage presented with intermittent rapid respiration and breath-holding spells of 1 hour and tonic posturing of all 4 limbs without uprolling of eyeball....
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XDR TB - What should be the treatment regimen now?
Pediatric Oncall
A 6 years old boy had non-resolving pneumonia. His bronchoalveolar lavage (BAL) showed the presence of acid-fast bacillus (AFB) on the smear. He was started on 4 drugs antituberculous therapy (ATT) co....
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Drug resistant TB
Pediatric Oncall
A 4 year old boy was referred for non-healing pulmonary TB. Past History: He was diagnosed to have pulmonary TB at the age of 2 years. His gastric lavage for acid fast bacillus was positive at that ....
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Is it Caroli’s disease?
Nupur Sanklecha
A 3-month-old boy born of non-consanguineous marriage presented with clay-colored stools since birth and jaundice along with high-colored urine for 8 days. He was born at full term by cesarean section....
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Cause of hypocalcemia
Pediatric Oncall
A two months old child born of non-consanguineous marriage presented with not gaining weight and lumps over the cheek. The child was a full-term delivery but did not cry immediately after birth and re....
H
Hepatitis A with hematemesis
Pediatric Oncall
A 4½ years old girl born of non-consanguineous marriage presented with 2-3 episodes of vomiting containing food particles following by coffee-colored vomitus and fever. There was no jaundice, pain in ....
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Neonatal hepatitis
Pediatric Oncall
A 3½ months old boy born of non-consanguineous marriage presented with jaundice since day 3 of life, fever, vomiting, and loose motions with blood for 3 days and swelling over left thigh for 2 days. T....
H
Hematemesis with hypotension
Pediatric Oncall
A 2-year-old girl presented with a small amount of blood in vomit 3 hours ago. There was no abdominal pain, retching, black stools, jaundice, or any drug ingestion. On examination, she had a pulse of ....
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Glycogen Storage Disease
Pediatric Oncall
A 2-year-old boy presented with fever, vomiting, and yellow-colored urine for 3 days with altered sensorium 1 hour prior to admission. He had jaundice at 4 months of age and was admitted for 1 month a....
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Hepatomegaly with infantile facies
Pediatric Oncall
A 4-year-old boy born of non-consanguineous marriage presented with gradual abdominal distension noticed by his mother for 6 months. There was no jaundice, pallor, bleeding from any site, convulsions,....
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Guillain Barre Syndrome
Pediatric Oncall
A 4½ years old boy presented with sudden weakness of both lower limbs for 7 days and breathing difficulty for 3 days. Weakness in lower limbs was ascending in nature and now the child was unable to st....
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Recurrent gastritis
Pediatric Oncall
An 8-year-old boy born of non-consanguineous marriage presented with recurrent episodes of hematemesis. He had the first episode 3 years ago which was coffee-colored associated with vomiting. He was t....
B
Bilateral cataracts
Pediatric Oncall
A 3-year-old male child born of non-consanguineous marriage presented with bilateral cataracts for 10 months. Birth history and milestones were normal. There was no jaundice, failure to thrive, or dys....
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Dehydration correction
Pediatric Oncall
A 1-year-old girl presented with fever, vomiting, and diarrhea for one day. She is on bottle feeds for 6 months, is immunized to date. On examination, she was dehydrated, had dry mucosa, delayed skin ....
F
Fever without focus
Pediatric Oncall
A 10-month-old girl presented with recurrent fever for 6 months. She was investigated for the same and hemoglobin was 11.6 mg/dl with a WBC count of 13,500/cumm [42% polymorphs, 58% lymphocytes], Ches....
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Febrile convulsion
Pediatric Oncall
A 3 years girl presented with recurrent fever for 4 months. It started with fever and cough and a convulsion 4 months ago when she was treated with valproic acid and diagnosed as febrile convulsion. S....
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Familial Hypercholesterolemia
Pediatric Oncall
A 2-year-old girl born of non-consanguineous marriage presented with abdominal distension and jaundice for 3 days. There was no history of previous jaundice or blood transfusion, and the child had no ....
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Typhoid fever
Pediatric Oncall
An 11 year old girl presented with remittent fever for 1 month and abdominal pain for 4 days. On examination, she had tachycardia, tender hepatomegaly and pallor. Investigations showed: • Hemoglobin ....
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Is it Hyper IgM syndrome?
Pediatric Oncall
A 3 months old boy born of non-consanguineous marriage presented with fever, cough and left focal convulsion for 1 day. On examination he had bulging anterior fontanelle with brisk reflexes and extens....
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URTI with wheeze
Pediatric Oncall
A 2 years old child presented with cold and cough (more at night) for 5 days and breathlessness for 1 day. There is no fever. Mother has recurrent sinusitis and is allergic to dust. There is no contac....
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Delayed development with light hair
Pediatric Oncall
A 2 years old boy born of non-consanguineous marriage presented with cough and fever for 7 days. There is no history of contact with TB. He also has delayed milestones and is not able to sit, roll ove....
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Purpura Fulminans
Pediatric Oncall
A 3 years old boy is found to have dry gangrene of right index finger, left little finger and 2nd and 3rd left toe. He had fever for 3 months and an erythematous rash 15 days ago.
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Urinary tract infection
Pediatric Oncall
A 10 month old girl presented with increased frequency of micturation, pain on passing urine and vomiting for 3 days. There is no fever, oliguria or refusal of feeds. On examination, there is no signi....
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Grunting
Pediatric Oncall
A 4 months old boy presented with cough for 5 days, fever for 2 days and breathlessness for 1 day associated with refusal of feeds and irritability. There is no altered sensorium or vomiting. On looki....
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Swelling over forearm and back
Pediatric Oncall
A 12 years old girl presented with fever for 3 days and painful swelling over the left forearm and left side of back for 2 days. There is no history of trauma or fall. On examination, there was a fluc....
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Hypernatremia
Pediatric Oncall
A 2½ months old boy born of non-consanguineous marriage presented with fever and staring look. He was admitted in a hospital and CSF was suggestive of pyomeningitis. He was treated with IV antibiotics....
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Meningoencephalitis
Pediatric Oncall
A 7-month-old boy born of non-consanguineous marriage presented with fever and irritability for 7 days and a staring look one day ago. Subsequently the child had become lethargic and did not recognize....
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Neonatal cholestasis
Pediatric Oncall
A 4-month-old female child born of non-consanguineous marriage presented with jaundice and high colored urine since birth. There was no history of clay colored stools. On examination, the child had ic....
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Acute hemolysis
Pediatric Oncall
A twelve years old male child born of third degree consanguineous marriage presented with fever for 10 days and high colored urine for 5 days. On examination, he had pallor, icterus and splenohepatome....
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Fever with multiple convulsions
Pediatric Oncall
A 2 month old boy born of non-consanguineous marriage presents with fever and cough of 3 days and multiple episodes of generalized tonic clonic convulsions in past 2 days. The child has 6-7 episodes o....
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Six Months Old with Uprolling of Eyes
Pediatric Oncall
A 6 months old girl born of non consanguineous marriage presented with multiple episodes of uprolling of eyes associated with bluish discoloration of lips and fingers. There was no loss of consciousne....
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Facial cavernous hemangioma with hypoplastic right cerebellar hemisphere
Pediatric Oncall
A 1 month old boy born of non consanguineous marriage presented with red coloured patches over right side of face, right eyelid and right side of up since birth with swelling in right check. There was....
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Transfusion dependent anemia
Pediatric Oncall
A 5 year old boy presented with lump on left side of abdomen since 1 year of age and recurrent anemia since 1 year of age for which he was given blood transfusion 4 times. He had been investigated for....
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Convulsions and jitteriness
Pediatric Oncall
A 2-month-old girl presented with recurrent episodes of tonic convulsions for 3 days lasting for 4-5 minutes without post ictal drowsiness. There is no history of fever, lethargy or refusal to feeds. ....
B
Bilateral congenital pedal edema
Pediatric Oncall
A 2 months old boy born of non-consanguineous marriage presented with swelling over both feet since birth. There was no increase or decrease in size of swelling. There was no breathlessness, edema els....
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Hepatosplenomegaly with cherry red spot
Pediatric Oncall
An 8-month-old boy born of non-consanguineous marriage presented with non achievement of any milestone. He was born at full term by normal vaginal delivery and there were no antenatal or post-natal co....
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Weakness with head lag
Pediatric Oncall
A 7-year-old boy born of non consanguineous marriage presented with fever, vomiting and increased sleepiness for 7 days and poor head control and weakness of lower limbs for 5 days. He had maculopapul....
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Tachypnea with hyperinflated chest
Pediatric Oncall
A 4 months old boy born of third degree consanguineous marriage presented with cough and cold for 7 days and increased rate of breathing for 3 days. There is no fever, refusal of feeds, lethargy. He i....
B
Breath holding spell at 6 months of age
Pediatric Oncall
A 6 months old boy born of non consanguineous marriage presented with recurrent episodes of turning blue while crying associated with holding of breath for past 1 month. There are 2-3 episodes/day. Th....
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Becker's Muscular Dystrophy
Pediatric Oncall
A 12 year old boy born of non consanguineous marriage presented with gradual weakness of all 4 limbs for 3 years. Weakness initially started in both legs with clumsiness of gait and frequent falls and....
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Gradual muscle weakness
Pediatric Oncall
A 12 year old boy born of non consanguineous marriage presented with gradual weakness of all 4 limbs since 3 years. Weakness initially started in both legs with clumsiness of gait and frequent falls a....
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Gastroenteritis, pleural effusion
Pediatric Oncall
A 1 year 8 months old boy presented with fever and diarrhea for 3 days and vomiting for 1 day. On examination, he had dry mucosa with delayed skin turgor. Vital parameters and systemic examination was....
A
Atypical Febrile Seizure
Pediatric Oncall
A 7-month-old boy born of non-consanguineous marriage presented with 3 episodes of convulsions in one hour, fever and cough, cold for 1 day. The 1st convulsion was generalized tonic-clonic associated ....
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Myelofibrosis, jaundice and scrotal swelling
Pediatric Oncall
A 4 years 8 months old boy presented with fever for 6 months, progressive abdominal distension for one month, epistaxis 20 days ago and bilateral swelling of feet since one day. He was diagnosed as my....
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Cola coloured urine with persistent low C3
Pediatric Oncall
A 2 year old girl presented with fever for 7 days and cola colored urine for 1 day. There was no oliguria, edema or vomiting. There was no history of any drug ingestion. On examination, blood pressure....
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Ptosis
Pediatric Oncall
A 3½ years old boy born of non-consanguineous marriage presented with diarrhea 15 days ago that lasted for 3 days and bilateral ptosis, dysarthria and fatigability since 1 day. There is no fever, conv....
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Vomiting, quadriparesis and tremors
Pediatric Oncall
A 4 years old boy presented with projectile vomiting for 3 months which subsided for 15 days in between, weakness of both lower limbs since 2 months which has now involved even the upper limbs for pas....
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Fever with Jaundice and Pallor
Pediatric Oncall
A 6 years old boy born of non-consanguineous marriage presented with jaundice without high colored urine for the past one month, fever for one week and pallor for past 2-3 days. The patient has been t....
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Metabolic disorder
Pediatric Oncall
A 6 years old girl born of third degree consanguineous marriage presented with repeated episodes of vomiting followed by altered sensorium and drowsiness. There was no fever or jaundice. She had norma....
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HIV and TB
Pediatric Oncall
A 5 years old boy was detected to have endobronchial TB at the age of 2 years and was on antituberculous therapy {ATT} for the past 3 years that included intermittent Streptomycin and Amikacin injecti....
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Jaundice, skin rash and anemia
Pediatric Oncall
This girl presented with jaundice, skin lesions and anemia of 15 days duration. She was diagnosed to have epilepsy and was started on phenytoin 2 months ago.
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Pneumonia in a 4 month old
Pediatric Oncall
A 4-month-old boy presented with fever, cough, cold for 5 days and breathlessness for 1 day with decreased appetite. He was a full term normal delivery without antenatal or postnatal complications on ....
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Hyperpigmentation with hypoglycemia
Pediatric Oncall
A 1½ months old girl born of non-consanguineous marriage at full term presented with uprolling of eyeballs 3 days ago. She had a similar episode on Day 3 of life. There was no fever. Parents had notic....
D
Diarrhea with blood in stools
Pediatric Oncall
An eight year old girl presented with diarrhea and blood in stools for 3 days associated with tenesmus and fever. Stools were watery associated with mucus 8-10 times/day. There was no history of vomiting, oliguria.
A
Anemia with hepatosplenomegaly
Pediatric Oncall
A 2½-month-old girl born to a primigravida mother presented with pallor. Mother was 24 years old. There is no history of jaundice, blood loss or trauma. The child was on exclusive breast feeds. On exa....
I
Irritability in a one and a half years old boy
Pediatric Oncall
A 1½ years old boy presented with fever and cough for 4 days. He had similar complaints 1 month ago for which he was hospitalized and treated with intravenous antibiotics for 7 days. He was admitted f....
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Fever and Ileus
Pediatric Oncall
A 22 months old girl presented with fever for 10 days, diarrhea and abdominal distension for 3 days. On examination, she was pale, heart rate was 104/min, capillary refill time (CRT) was < 3 seconds. ....
A
ATAXIA
Pediatric Oncall
A 5 years boy born of non-consanguineous marriage presented with ataxia, frequent falls during walking and weakness of lower limbs for 1 year. Mother also noticed intermittent tremulousness of lower l....
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Vomiting in a child with epilepsy
Pediatric Oncall
A 4½ years old boy presented with vomiting for 3 days. He has epilepsy since 1½ years of age and has an episode of seizure once in 15 days. He was on carbamazepine and phenytoin for the same. Carbamaz....
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BRONCHOGENIC CYST
Pediatric Oncall
An 11-month-old boy born of non-consanguineous marriage presented with a cough for 15 days and fever and breathlessness for 3 days. He had similar complaints at the age of 7 months and was hospitalize....
C
Congenital edema of feet
Pediatric Oncall
A 7 year old girl presented with edema of feet since birth. She is otherwise asymptomatic. On examination apart from edema feet (non-pitting) and skin denudation over edema, the rest of examination is normal.
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Subcutaneous Fat Necrosis
Pediatric Oncall
A 1½ month old girl born of non consanguineous marriage presented with fever for 5 days, thickening of skin over back, arms since 15 days of life. She was a post term caesarean section with meconium a....
I
Is it asthma?
Pediatric Oncall
A 9 months old boy born of third degree consanguineous marriage presented with recurrent cold and cough (more in mornings) for one and a half months associated with fever. Every time he was treated wi....
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Fever for 15 days with one episode of convulsion
Pediatric Oncall
A 1 year old girl born of non consanguineous marriage presented with fever and cough for 15 days. She had an episode of generalized tonic clonic convulsion 1 hour ago with frothing from month and last....
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Fever, rash and convulsions
Pediatric Oncall
A 2½ years old boy born of third degree consanguineous marriage presented with fever since 6 days and maculopapular rash since 2 days. He had a generalized tonic clonic convulsion 2 hours back with po....
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Is it WILSON’S DISEASE?
Pediatric Oncall
A 9 years old boy born of non-consanguineous marriage presented with jaundice since 20 days. His older brother had also died due to jaundice. On examination, he had icterus with firm hepatosplenomegal....
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TBM WITH TUBERCULOMA
Pediatric Oncall
A 2½ years old boy presented with fever and vomiting for 9 days. He was detected to have tuberculous meningitis (TBM) at the age of 1½ years in view of right sided hemiparesis with communicating hydro....
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Ventriculitis with basal exudates in a 2 ½ months old.
Pediatric Oncall
A 2½ month old girl presented with enlarging head size, inability to move the right side of body and deviation of face on left side for 1 month. The child was born of a caesarean delivery in-view of o....
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TUBERCULOSIS WITH HYPER IgE
Pediatric Oncall
An 8 years old boy presented with cough for 4 months. His Mantoux test was 22 mm and chest X-Ray was suggestive of primary complex. In view of recurrent cough, a serum IgE was done that was elevated (....
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TUBERCULOSIS WITH THROMBOCYTOPENIA ON TREATMENT
Pediatric Oncall
A 9 years old boy presented in with multiple neck swellings and weight loss for 2 months. Elder sister was diagnosed as multi drug resistant tuberculosis (MDR-TB) and was on second line antituberculos....
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TB POLYSEROSITIS
Pediatric Oncall
A one year old boy presented with cough and fever for 7 days. There was no TB contact. On examination, his weight was 7.7kg. He had respiratory distress with cardiomegaly and bilateral pleural effusio....
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Fever with jaundice
Pediatric Oncall
A 7 years old boy presented with fever for 7 days and jaundice at onset of fever followed by generalized edema for past 3 days. He was admitted in a hospital for the same and diagnosed as enteric feve....
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PUO
Pediatric Oncall
A 3 year old girl presented with fever for 1 month, cough since 15 days and vomiting for a day. There was no urinary or bowel complaints. She was treated with antibiotics and antimalarials for the sam....
N
NON-RESOLVING PULMONARY TB
Pediatric Oncall
A 4 years old boy presented with cough and breathlessness for one month. His Chest X-Ray showed multiple nodular lesions in lung and CT chest showed extensive bilateral patchy consolidation with nodul....
N
Neuroregression
Pediatric Oncall
A 9 months old boy born of third degree consanguineous marriage presented with loss of milestones after 4 months of age. At 4 months of age, the child had social smile with partial head holding. He ha....
A
A 2 year old with stiff neck and back- is is polymyositis?
Pediatric Oncall
A 2 years old girl presented with progressive swelling over neck and back since 15 days with inability to move neck and back. She had a fall on her occiput 1 month back. She had right sided congenital....
A
Ambiguous genitalia
Pediatric Oncall
A 2 months old child born of non-consanguineous marriage presents with abnormal genitalia. On examination, the phallus was 2.75 cm with single opening, partially fused labia with gonads not palpable and hyperpigmentation of gonads.
A
Antituberculous drugs and rash
Pediatric Oncall
A 4½ years old girl presented with fever for 15 days, headache for 7 days and stiffness of legs for 7 days. She had meningeal signs on examination. CSF showed 3,900 cells/cumm (78% polymorphs, 22% lym....
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PUO with hematuria
Pediatric Oncall
A 10 years old girl presented with fever for a month and microscopic hematuria. She had persistent headache. There was no organomegaly and systemic examination was normal. On investigations, hemogram,....
F
Forgotten dog bite
Pediatric Oncall
A 10 years old boy had a dog bite by a street dog a year ago. The boy did not inform his parents that he had a dog bite. A year later, he informed his parents about the dog bite. The street dog was not seen after a few days after the bite.
A
Acute hepatitis with Positive Hepatitis A virus IgM and Positive HBsAg
Pediatric Oncall
A 9 1/ 2 years old boy was diagnosed to have acute hepatitis. The referring pediatrician had done Hepatitis A virus {HAV} IgM which was positive. HBsAg which was also positive. Mother was also HBsAg p....
S
Skin TB with Vascular occlusion
Pediatric Oncall
A 3 years old girl presented with hyper pigmented macules over left inguinal region. She was diagnosed to have cutaneous TB on skin biopsy and was on anti TB therapy for past 1 year. A repeat skin bio....
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Granuloma – Is it TB_?
Pediatric Oncall
A 15 years old boy was diagnosed to have neurocysticercosis in June 2011. CT scan showed left parietal nodular lesion with mild perilesional edema with tiny scolex. A repeat MRI scan in July 2011 show....
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Is it NK cell deficiency_?
Pediatric Oncall
A 3½ years old girl born of third degree consanguineous marriage presented in Dec 2014 with recurrent fever for the past 8 months. She had suffered from liver abscess in March 2014 {ultrasound showed ....
E
Epidural and psoas abscess
Pediatric Oncall
A 4½ years old girl presented with fever and frontal headache for 15 days with lower limb tightness for 10 days. Her physician did a cerebrospinal fluid analysis that showed 3900 cells, hpf {78 percen....
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Persistent pleural effusion
Pediatric Oncall
A 12 years old boy presented with fever and dry cough for 1 month. He was detected to have right sided pleural effusion. His elder brother had fibrocavitatory TB and was on antituberculous therapy {AT....
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HOW TO TREAT THIS TB_?
Pediatric Oncall
A 2½ years old boy suffering from steroid resistant nephrotic syndrome on cyclophosphamide and steroids and on antituberculous therapy {ATT} since past 10 months was referred for further management. H....
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METABOLIC LIVER DISEASE
Pediatric Oncall
A 1 year old girl born of non consanguineous marriage presented with fever, cough and cold for 4 days and respiratory distress for one day. She had delayed milestones. Birth history was normal. On exa....
I
Involuntary movements in a one and a half year old
Pediatric Oncall
A 1½ year old boy born of non-consanguineous marriage presented with involuntary movements of entire body since 6 months. There were no precipitating factors and milestones were normal upto 6 months o....
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HEPATOBLASTOMA WITH TOXOPLASMA
Pediatric Oncall
A 6 months old boy presented with progressively increasing swelling on right side of abdomen along with jaundice and clay stools for 1 week. He was detected to have hepatoblastoma at 3 months of age f....
W
What could be happening in this child. Is it an IEM
bhaskar naik
This is a 10 months old female child born to consanguinous parents. Admitted with focal convulsions involving left lower limb. Past history of seizures on day 3 of life, and at 7 months of age, then E....
S
Spastic Diplegic CP or Neurodegenerative disorder
Kiran Basavaraja
A 5 years old previously normal boy was detected to have gait abnormality at 3.5 years. Parents showed the child to a paediatric orthopaedician who made the diagnosis of spastic diplegic CP and advise....
A
Acute liver injury with cardiac involvement
Pediatric Oncall
A 5 years old boy presented with generalized edema, 2 episodes of vomiting and respiratory distress. He required ventilatory care and ionotropes in view of ejection fraction of 57 percent. He was dete....
N
Neonatal Cholestasis - Is it tyrosinemia_?
Pediatric Oncall
A 3 month old boy born of non-consanguineous marriage presented with jaundice and clay coloured stools for 2 months. He was born at 34 weeks and had a birth weight of 2 kg but did not cry immediately ....
C
CHYLOUS ASCITES IN INFANCY
Pediatric Oncall
A 6 months old boy presented with abdominal distension for 5 days. On examination, he had ascites with hepatomegaly and weight of 5 kg. At birth, he developed hypoglycemic convulsions on Day 4 of life....
L
Lump in abdomen
Pediatric Oncall
An 11 years old girl hailing from Bihar, presented with pain in abdomen for 1½ months. There was no jaundice or fever. She has received blood transfusion for same and was started on 3 drugs antituberc....
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Which metabolic screening report to believe_?
Pediatric Oncall
A 4 months old boy born of non-consanguineous marriage presented with fever for 15 days, vomiting and loose motions for 8 days and passing clay colored stools for 2 days and altered sensorium for 1 da....
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Rickets with low serum ceruloplasmin
Pediatric Oncall
A 9 years 8 months old girl born of non consanguineous marriage presented with knock knees and difficultly in walking. She was diagnosed to have rickets in view of low 25-hydroxy Vitamin D and 1, 25 d....
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Is it Wilson`s disease_?
Pediatric Oncall
An 8 years old girl was found to have low serum ceruloplasmin and normal liver function tests on screening. She was referred to rule out Wilson’s disease. Father had died recently with cirrhosis and s....
I
Is it really biliary atresia_?
Pediatric Oncall
A 10 years old boy presented with ascites and joint stiffness for 1 month. He was operated at 4 months of age for biliary atresia and a Kasai surgery was done. There is a history of neonatal ichthyosi....
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HLH and autoimmune hepatitis
Pediatric Oncall
A 2½ years old presented with jaundice for 1 month and fever for 15 days. He had been started on anti TB treatment {ATT} 7 months ago following which he had jaundice after a month and ATT was modified....
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Lump in abdomen
Pediatric Oncall
A 1 month old girl presented with abdominal distension for 5 days. Birth history was normal and she had achieved social smile. On examination, weight was 3.3 kg, she had pallor and an abdominal lump o....
R
RECURRENT CMV INFECTION
Pediatric Oncall
A 2½ months old girl presented with neonatal cholestasis with yellow stools. Elder sibling also had neonatal hepatitis with cytomegalovirus {CMV} infection and was treated with valganciclovir. In this....
R
Recurrent ascites
Pediatric Oncall
An 8 years old boy had loss of consciousness for 3 days 3 years ago along with abdominal distension following which he was hospitalized and subsequently got better. He also had fracture of right humer....
R
Recurrent jaundice with pruritis
Pediatric Oncall
A 10 months old boy born of third degree consanguineous marriage presented with recurrent jaundice and itching all over the body since 3 months of age. Elder sibling had also died of similar complaint....
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HYPOPARATHYROIDISM WITH CHOLELITHIASIS
Pediatric Oncall
A 16 years old boy presented in 2010 with right sided abdominal pain for 15 days. There was no jaundice. He was diagnosed to have hypoparathyroidism in 2003 and was on Rocaltrol {0.75 µg, day} and cal....
I
IPT for recurrent TB exposure
Kumar G S
Three children aged less than 6years (youngest being 3yrs) have been given 6 months of INH prophylactic therapy as per RNTCP recommendations (10mg/Kg/day) as the grandfather had smear positive tubercu....
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Bulging anterior fontanelle
Pediatric Oncall
An 11 month old child is lying on the bed. He looks toxic, has a bulging anterior fontanelle. When the mother tries to lift the child, he screams when she holds the neck and neck appears to be stiff. ....
T
Thrombocytopenia-Is it vWD type B
Prabhat Kumar
An 8 years old girl came with extensive petechiae and purpura over whole body for last 3 years which occurred spontaneously or after minor trauma or even after mosquito bite. On examination, she had n....
A
ACUTE ONSET NECK FLOP IN INFANT
KRITISUNDAR RANA
A 10 month old baby presented with sudden onset non progressive neck flop for 1 day with no history of fever, convulsion or any cause of dyselectrolytemia like diarrhea, vomiting. Child had fever 10 d....
N
Non resolving pneumoniae
krishanu mondal
A 5 months old girl born by non consanguineous marriage presented with low intermittent fever with cough and respiratory distress for last 15 days. She was term, normal delivery, neonatal period was ....
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FULMINANT HEPATIC FAILURE
Pediatric Oncall
A 3 months old boy born of non consanguineous marriage presented with bilateral conjunctivitis, diarrhea and vomiting 10 days ago that resolved in next 2 days` progressive abdominal distension and fev....
C
Congenital TB
Pediatric Oncall
A 3 months old boy had been started on antituberculous therapy {ATT} consisting of Isoniazid , Rifampicin and Pyrazinamide since birth as mother was diagnosed to have pulmonary TB one day prior to del....
P
Portal cavernoma with pancytopenia
Pediatric Oncall
A 5 years old boy was detected to have extrahepatic portal hypertension due to massive splenomegaly. There was no hematemesis. Colour doppler showed portal cavernoma. Oesophageogastroscopy showed 1 sm....
E
EPITROCHEAL LYMPHADENOPATHY
Pediatric Oncall
A 9 years old boy presented with swelling in right elbow which was increasing since past 5 months. He had been treated with antituberculous therapy {ATT} for 6 months but the swelling persisted. A bio....
P
Polyserositis
Pediatric Oncall
An 8 years old girl presented with recurrent fever for past 1 month. She had an exanthematous rash 2 months ago along with fever that subsided in 3 days. Now she has fever with chills and rigors for o....
A
A 4½ years old boy with recurrent persistent diarrhea
Pediatric Oncall
A 4½ year old boy presented with recurrent diarrhea. He had first episode of persistent diarrhea at 3½ years of age associated with weight loss and was diagnosed to have TB and was given antitubercul....
R
RELAPSED PULMONARY TB- STILL DRUG SENSITIVE _?
Pediatric Oncall
Case:- A 14 years old girl presented with fever, cough and loss of appetite for 5 months and hemoptysis 3 days ago. She was on antituberculous therapy {ATT} since the past 6 months but had no relief. ....
F
Fever with petechiae
Pediatric Oncall
A 2 years old boy presented with fever for 1 month. He was shown to a doctor who treated him with artesunate, pyrimethamine – Sulphadoxine and blood transfusion following which fever subsided. He agai....
M
Meningomyelocele
Pediatric Oncall
A 2 month old girl born of non consanguineous marriage presented with hydrocephalus and meningomyelocele diagnosed since birth and excessive crying for 4-5 days. The child had 2 episodes of seizures i....
L
LABORATORY PARAMETERS IN IRON DEFICIENCY ANAEMIA
Vidya Prakash Fadnis
Recently I came across 2 babies: one 2 yrs old and other 3yrs old with sever pallor. Both parents gave history of pica, history of prolong breast feeding with inadequate and improper weaning food. Par....
I
Is it TB_?
Pediatric Oncall
A 12 years old child presented with cough for 8 days with breathlessness. She was treated with Azithromycin and Salbutamol to which she responded. Her Chest X-Ray showed right sided calcified perihila....
T
TB – IS IT RESIDUAL DISEASE
Pediatric Oncall
A 3 years 8 months old child presented with recurrent cough and cold. His grandmother was on antituberculous therapy {ATT} for past 6 months. For the same, the child had been started on ATT for past 6....
K
Kikuchi disease
Pediatric Oncall
A 12 years old girl presented with swelling on left side of neck for 5-6 months which was gradually increasing in size. There was no contact with tuberculosis. On examination, weight was 49 kg, heigh....
H
Hypertriglyceridemia
Pediatric Oncall
A 2 years old girl presented with pallor without organomegaly. She had hyperpigmentation of fingers. Her hemogram showed pancytopenia with megaloblastic changes. Her Vitamin B12 levels were normal ....
T
TBM with hyperthermia
Pediatric Oncall
A 4 month old girl presented with lethargy, one episode of tonic clonic convulsion and fever for a day. There was no contact with TB. Patient was hospitalized for pneumonia 14 days back for 6 days and....
H
HEPATOBLASTOMA
Pediatric Oncall
An 8 months old boy was diagnosed as hepatoblastoma at 4 months of age for which he underwent chemotherapy {4 cycles of PLADO regimen} and subsequently underwent right sided extensive hepatic resectio....
N
NEONATAL HEPATITIS WITH MOTHER HBsAg positive
Pediatric Oncall
A one month old boy born of non consanguineous marriage presented with jaundice without clay coloured stools for 3 days. Mother was a chronic carrier of Hepatitis B and had jaundice at 18 years of age....
R
RECURRENT HEMATEMESIS
Pediatric Oncall
A 4 months old boy born of non consanguineous marriage presented with repeated episodes of hematemesis 25 days ago. The vomit consisted of blood clots and he was admitted in a nursing home where stoma....
M
Mediastinal mass
Pediatric Oncall
A 4 months old boy presented with fever and cough for 7 days. His chest X-Ray had shown right upper and mid zone consolidation for which he had received ceftriaxone-sulbactum and amikacin for 7 days b....
T
Transient Hypertension with Hypertensive emergency in
Jyoti Sharma
A 15 year old adolescent presented with history of generalized swelling, which started with periorbital puffiness that progressed cephalocaudaly and hematuria for 5 days prior to admission.He had no p....
K
Kalaazar in child who has not visited endemic area
Pediatric Oncall
An 11 month old girl resident of Mumbai born of non consanguineous marriage presented with cough and fever since 15-20 days. She had diarrhea with septic shock, meningitis and anemia 2 months back for....
H
Hepatosplenomegaly with bicytopenia
Pediatric Oncall
A 2 years old girl presented with lump on left side of abdomen for 6 months. There was no pallor or jaundice. On examination, she had splenohepatomegaly with palmar erythema and cervical adenopathy. W....
D
DENGUE ALONG WITH PORTAL HYPERTENSION
Pediatric Oncall
A 5 years old boy with congenital temporo-mandibular joint ankylosis was operated for same following which he developed fever 8 days post-operatively with 2 episodes of hematemesis. There was no jaund....
L
Liver abscess
Pediatric Oncall
Case Report: - A 7 year old girl born of non consanguineous marriage presented with fever for 1 week and anorexia and weight loss for 3 months. She was on Antituberculous Therapy {ATT} since 3 months ....
C
Chronic hepatitis with myopathy
Pediatric Oncall
A 1½ years old boy had fever with elevated liver enzyme sin January 2009. He continued to have persistently elevated liver enzymes and was referred in May 2009 for further management. There was no jau....
I
IS IT MULTIFOCAL BONE TB_?
Pediatric Oncall
A 4 years old boy presented with jaundice, ascitis, hepatomegaly and multiple abscesses over sternum and back for which he was on antituberculous therapy {ATT} for past 1 month. He was treated for tub....
T
TB CONTACT AT 9 YEARS
Pediatric Oncall
A 9 years old girl was screened for tuberculosis as brother had open TB. Her Chest X-Ray was normal and Mantoux test was 12 mm. Child was otherwise asymptomatic.
C
Chronic hepatitis
Pediatric Oncall
A 2½ years old boy presented in Jan 2009 with incidentally detected hepatomegaly. There was no jaundice, fever or vomiting. On examination, weight was 12 kg, height was 85.8 cm and there was hepatomeg....
R
Recurrent pericardial effusion in a girl not responding to treatment
Suwansh Meshram, Amit Nagpal, Tushar Jagzape, Bhavna Lakhkar
A 13 years old girl resident of Yavatmal, Maharashtra born of non consanguineous marriage was admitted with chief complaints of decreased appetite and lethargy since one year and difficulty in breathi....
I
Is it Wilson’s disease or Indian Childhood Cirrhosis_?
Pediatric Oncall
A 1 year 8 months old boy born of non consanguineous marriage presented with abdominal distension for a month and jaundice for 15 days. On examination, he had hepatosplenomegaly with firm hepatomegaly....
I
Inspiratory wheeze
Pediatric Oncall
A 1½ years old boy presented with cough with noisy breathing for 2 days and breathlessness since the afternoon. There is no fever, foreign body ingestion. He had similar complaints 4-5 times last year....
P
PUO
Pediatric Oncall
Case Report: - A 5 years old boy presented with remittent fever for 2½ months. There is no cough, urine or bowel complaints or contact with TB. He was treated with various antibiotics – Piperacillin p....
C
Chorea
Pediatric Oncall
A 10 years old boy presented with purposeless involuntary movements of right side of body for past 2 days which disappeared in sleep and accompanied by emotional liability. There is no fever, jaundice....
T
Tuberculous meningitis
Pediatric Oncall
A 4½ years old girl presented with fever for 15 days, headache for 7 days and stiffness of legs for 7 days. Patient was admitted in a hospital a week back and treated with IV Fluids and IV antibiotics....
D
Dilated Cardiomyopathy
Pediatric Oncall
A 5 month old girl born of non consanguineous marriage presented with cough and cold since 1½ months of age and breathlessness with suck-rest-suck cycle since 2½ months of age with gradual increase in....
I
Is it Wiskott Aldrich Syndrome_?
Pediatric Oncall
A 6 years old boy presented with fever for 2 months and cough for 15 days. He had been treated for abdominal TB 2 years ago for 9 months. On examination, his weight was 16 kg. Other systems were norma....
S
Short stature
Naji Ahmed
A 14 years old girl presented with short stature. Weight is 44kg {25th centile}, length is 144cm {below 3rd centile}. Past medical history reveals affection with alopecia and vitiligo for which she re....
D
Dysmorphic syndrome
Jose Samos
A six days old male neonate born of non-consanguineous marriage to a mother multiparous {G9} aged 34 years had bilateral anophthalmos, right auricle and auditory canal agenesis. Two siblings aged 2 an....
D
Dilemma Case
Naji Ahmed
T is a 12 year old girl born of consanguineous marriage, presented with tachypnea, easy fatigability, abdominal distention of 3 weeks duration. She has past history of progressive generalized muscle w....
I
Infectious Disease
Vamshidhar
A 7yr old male child presented with 4 days history of high grade fever along with faint erythematous macular rash on chest and hands and numerous petechiae on soft palate noted on day 2 of fever. He w....
I
Irritability
Pediatric Oncall
A 10 months old boy presented with fever for 7 days and excessive crying for 6 days. Fever was accompanied by vomiting initially which subsided within 2 days. Mother had open tuberculosis and was on a....
H
Hematemesis
Pediatric Oncall
A 4 year old child presented with seizures {GTC – clenching of teeth} 1 day back and hematemesis {coffee coloured} next day morning. On examination, there was no abnormality detected. Investigations s....
P
Post BCG axillary lymphadenitis
EMAN FOUDA
A 10 months old girl presented with left sided axillary lymphadenitis. There is no other lymphnode enlargement. Chest is clear and there is no fever. These lymph nodes burst spontaneously with caseou....
M
Myocardial calcinosis
Malika
Ten year old boy with myocardial calcinosis born from consanguineous marriage was admitted to cardiology department. At the age of 11 months he presented with the restriction of coxal joint movement. ....
I
ILEAL PERFORATION IN A CHILD WITH DISSEMINATED TB
Pediatric Oncall
An 8 years old boy presented with dry cough and low grade fever for 6 months, constipation for 2 months with pain on left side of abdomen for 1 month. Uncle had tuberculosis and had died due to same. ....
A
Antiretroviral therapy- Underdosing
Pediatric Oncall
An 11 years old HIV infected boy on antiretroviral therapy {ART} consisting of Stavudine {d4T} 30 mg, Lamivudine {3TC} 150 mg and Nevirapine {NVP} 200 mg for the past 1 year was referred for further m....
N
Neurocysticercosis or tuberculoma
Pediatric Oncall
An 8 years old girl had a right sided focal convulsion 5 months back. MRI brain at that time was suggestive of well defined ring enhancing. T2 hyperintense conglomerate lesions in left high parietal r....
L
LYMLPHOPENIA IN TB
Pediatric Oncall
A 7 years old boy had fever with limping 4 months back and left hip arthritis was detected for which arthrotomy was done and pus smear showed acid fast bacilli {AFB}. He was started on 4 drug antitube....
D
DILATED CARDIOMYOPATHY WITH CAVITATORY TB
Pediatric Oncall
A 1½ years old girl presented with cough for 15 days and breathlessness for 8 days in November 2009. She was treated for pulmonary TB in April 2009 for 6 months. Grandfather had tuberculosis 1 year ba....
I
Increased amylase in HIV infected child
Pediatric Oncall
A 5½ years old HIV infected boy was referred for further management. He had recurrent cough and cold. On examination weight was 13 kg. He had generalized lymphadenopathy oral thrush, clubbing and pall....
H
HIV and TB
Pediatric Oncall
A 5 years old boy was detected to have endobronchial TB at age of 2 years and was on antituberculous therapy {ATT} for past 3 years that included intermittent Streptomycin and Amikacin injections. Cur....
R
Ring enhancing granulomas on MRI brain and measles
Pediatric Oncall
A 7 years old girl presented with multiple episodes of convulsions in 7 days. She had first episode of generalized tonic clonic convulsion at 5 years of age with a frequency of once in 2-3 months and ....
A
Abdominal lymphnodes and positive mantoux test
Pediatric Oncall
A 7½ years old girl had abdominal pain for 10 days. Ultrasound abdomen showed enlarged mesenteric lymphnodes {1.6 x 0.7 cm}. Her mantoux test with 5 TU was positive {16 x 14 mm}. She was treated with ....
P
PU valves
Sudipta Das
I am treating a boy who is now 3 year old. At the age of 8 month he was presenting with poor weight gain and urinary tract infection {UTI}. He was diagnosed as a case of posterior urethral valve {PU v....
H
HIV and bronchiectasis
Pediatric Oncall
A 7 years old HIV infected girl presented with cough for 2 months and fever for 2 months. Both parents were on antiretroviral therapy {ART} and father had tuberculosis {TB} 3 years ago and mother had ....
P
Pneumonia with hepatitis responding to clindamycin
Pediatric Oncall
A 5½ years old boy presented with recurrent fever and jaundice for 1½ months, with right ankle pain for 7 days. He had Widal positive {0 titre= 1:160} and was treated with cefaperazone for 10 days to ....
A
Anti TB therapy and hepatitis
Pediatric Oncall
A 6 years old boy was detected to have right pleural effusion with positive Mantoux test for which he was started on 4 drug antituberculous therapy {ATT}. One month later, he developed hepatitis and I....
H
Hypoplastic marrow
Narasimhappa
A 10 years old girl presented to us with jaundice for 10 days and fever for 3 days. On examination, there was icterus, purpura, ecchymoses, anemia and firm liver of 6-7 cm below costal margin {which ....
I
Is it TB_?
Pediatric Oncall
A 5½ years old girl presented with cough, cold and tachypnea for a month along with loss of appetite for which child had been started on 4 drug anti tuberculous therapy {ATT} by her physician. There w....
P
Positive Mantoux Test
Pediatric Oncall
A 2 years old boy presented with dry cough for 1 month. There is no fever or loss of appetite though he has not put on any weight in past 6 months. There is no contact with tuberculosis. On examinatio....
R
Recurrent fractures with recurrent infections
Pediatric Oncall
A 7 years old boy has had 12 fractures till date which started from 1½ months of age without trauma. He also has had recurrent infections in form of chronic diarrhea, recurrent cough with snoring and ....
W
White out lung
Priti Rani
A 6 days old newborn developed sudden respiratory distress and was referred for admission. He was tachypneic with subcostal chest indrawing, heart rate was 160, and CRT was prolonged. The child was de....
I
Is it Drug Resistant TB
Pediatric Oncall
A 14 months old boy on antituberculous therapy {ATT} since past 3 months had left sided cervical swelling with fever for 15 days. At 11 months of age, he had fever and Mantoux test was positive and he....
P
Preterm with sepsis
Pediatric Oncall
A 30 week AGA born to a primigravida mother was referred to NICU for routine preterm care. His birth weight was 1.25 kg and he had cried immediately after birth but required oxygen after birth. Mother....
A
A 6 years old with rickets
Ira Shah
Case: - A 6 years old girl born of non consanguineous marriage presented with rachitic changes in limbs since 1½ years of age for which he has received multiple courses of vitamin D. There is no polyu....
O
Osteogenesis imperfecta
Pediatric Oncall
A 4½ years old boy presented with multiple fractures since 1½ months of age. He had fracture in bilateral arms at 1½ months of age without trauma. Second fracture in left leg and right clavicle occurr....
T
TB culture
Pediatric Oncall
A 6½ years old HIV infected girl on antiretroviral therapy {ART} for 1½ years consisting of Stavudine {d4T}, Lamivudine {3TC} and Nevirapine {NVP} presented with fever, vomiting and pain in abdomen fo....
T
TUBERCULAR PERICARDIAL EFFUSION and DRUG INDUCED HEPATITIS
Pediatric Oncall
A 1 year old boy presented with generalized edema for 15 days along with breathlessness for 5 days. He had intermittent fever for past one month. There was no oliguria, jaundice or failure to thrive. ....
N
Neonatal Cholestasis
Pediatric Oncall
A 3½ months old boy born of non-consanguineous marriage presented with jaundice since Day 3 of life, fever, vomiting and loose motions with blood for 3 days and swelling over left thigh since 2 days. ....
C
Congenital Microvillus Atrophy
Broca
A 6 months old boy old suffers from continuous diarrhea since 24 hours of his birth and has been in hospital since birth. If he does not get IV fluids, he deteriorates very shortly because of dehydra....
U
Urticaria with shock and elevated D-Dimers
Pediatric Oncall
A 16 month old boy born of non consanguineous marriage presented with boil over scalp since 15 days, urticarial rash since 3 days and fever since 2 days. Patient was treated with some medications for ....
H
Hypertriglyceridemia in 6 month
Rimjhim Shrivastava, PGI
vaginal delivery cried after 5-7 min but the immediate postnatal period was uneventful. At 3 month of age, he presented with fever and diarrhea. For this he was admitted and was found to have sodium o....
A
AKT INDUCED FULMINANT HEPATIC FAILURE
Pediatric Oncall
A 20 months old girl presented with jaundice for 1½ months and bleeding per rectum one episode. There was no hematemesis. She had edema all over body for past 3 days and altered sensorium for one day.....
R
Resistant focal seizure with involuntary movements
Ankur Patel
A 12 yr old boy born of non consanguineous marriage was admitted with focal seizure with involuntary movements. He is a known case of seizure disorder diagnosed one year ago and was already on combina....
C
Conjugated Hyperbilirubinemia
Zainul Gagan
A 4 day old child was brought by parents with the complaints of yellowish discoloration of skin. On examination there was hepatosplenomegaly. Investigations revealed bilirubin level of 45 with direct ....
S
Short Stature
Sujit Ranjane
5 years old boy came with not gaining height. He is 2nd issue of 3rd degree consanguineous marriage of Muslim community. First sibling is 8yrs old male with normal height and weight. Mother gives sim....
P
Persistent Vomiting, Abdominal Pain with Persistent Hyponatremia and Underdeveloped Genitalia
Neeraj Gupta
An 8 ½ years old child presented with persistent vomiting and pain in abdomen for 3-4 days. The child took treatment outside but had no improvement. Got admitted with us and the symptoms were relieved....
I
Infantile ascitis
Hany Mosa
A 3 months old male presented by progressing abdominal distension with no fever. There is oliguria and decreased oral intake. Examination revealed general condition good with stable vital signs and af....
C
Complete collapse lung
Mehboob Sultan
we have a 9yr old girl with a year long {at least} complete right lung collapse with consolidation. Already completed 9 mo anti TB treatment with no releif. Presently she is on multi drug resistent an....
F
Fever and anemia
Baldeep Singh
A 6 month old girl born of non-consanguineous marriage, resident of Punjab {Northern India}, presented with fever for 2 days and severe anemia {HB-3gm, dl}. She was transfused one unit of blood follow....
R
Recurrent infections
Pediatric Oncall
A 9 year old girl born of non consanguineous marriage presented with recurrent cough with copious sputum more in morning and breathlessness since 1 year of age. She had joint pains with morning stiffn....
G
Glycosuria
Jagdish Menghani
A 10 years girl presented with increased frequency of urine {gets up 6-8 times in night and polyuria}, ants on voided urine and warm body for 2months. There is contact with patient of tuberculosis. On....
P
Proteinuria
Pediatric Oncall
Case Report: - An 8 year old boy presented with primary nocturnal enuresis and mild puffiness of eyelids since 1 year. There was no hypertension and examination findings were normal {Height = 125 cm}.....
P
Pericardial Effusion with Bilateral Pleural Effusion and Bronchiectasis
Pediatric Oncall
A 14 month old girl presented with fever and cough since 15 days and breathlessness since 3 days. She had measles followed by pneumonia at 9 months of age following which patient has had increased res....
P
Periodic Paralysis Vs Seizures
Ganga Chandramohan
A 2 month old boy presented with a history of 2 episodes of shaking movements followed by eyes rolling back and becoming limp that occured hours apart. Also had diarrhea on that day. Physical exam was....
N
NON TB – EPITROCHEAL LYMPHNODE
Pediatric Oncall
A 9 years old boy presented with swelling over right elbow 1½ years back which was progressively increasing in size, painful and associated with fever. An incision and drainage was done and pus was dr....
A
Acute urticaria in a 2 1, 2 months old child
Pediatric Oncall
A 2½ month old boy born of non consanguineous marriage presented urticarial rash over face and hands since 20 days. There is no history of any drug ingestion and is on formula feeds since birth. He wa....
C
Cryptogenic Vesicular rash
Vivek chetal
A four year old child presents with a history of recurrent vesicular rash on the face, predominantly around peri-oral region and spreading towards scalp, getting exacerbated with fever for past two ye....
R
Recurrent UTI
Sudipta Das
I am treating a baby {age 1 year and six month, weight: 9 Kg} with complain of poor weight gain and recurrent fever till 7 month of age. He had two documented UTI {proved by Urine Culture}at the age o....
 
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