Fever with thrombocytopenia

Author: Pediatric Oncall

Question
A 4-year-old boy born of non-consanguineous marriage presented with fever for 6 days and decreased urine output. There was difficulty in walking due to a wide-based gait for 6 days and pain in the left hip. He has had a right eye paralytic squint since birth. He was a full-term delivery at home and his mother had a fever in the 8th month of pregnancy. He had convulsion at 6 months and 3½ years of age with fever. EEG done was normal. MRI was suggestive of cortical dysplasia and hypoplastic corpus callosum with mild Dandy-Walker Variant. Milestones were normal and the child is not on any anticonvulsants. On examination, there was pallor, petechiae on the left hand, right convergent squint, wide-based gait with normal deep tendon reflexes. There was no neck stiffness or hepatosplenomegaly. Other systems were normal. IQ test = 95. Investigations showed:
• Hemoglobin = 8.2 gm/dl
• WBC count = 11,100/cumm (20% polymorphs, 80% lymphocytes)
• Platelet count = 39,000/cumm
• ESR = 60 mm Hg
• SGPT = 15 IU/L
• Renal function tests, serum electrolytes
• Urine = Normal
• Prothrombin Time, Partial thromboplastin time = Normal
• Dengue ELISA, Leptospira tridot = Negative
• Peripheral smear = Atypical lymphocytes with decreased platelet
• X-Ray lower limbs and ultrasound of hip = Normal
• CPK = 24 IU/L
• Blood culture = Negative
• HIV = Negative

He gradually showed improving platelet count and decreasing neutrophil count. His gait improved gradually. However, he continued to have neutropenia, and subsequently, even the hemoglobin and platelet count again dropped over a period of 15 days.
• CMV, EBV = Negative
• Bone marrow aspirate = Dilute marrow

What is the diagnosis?

What is the diagnosis?

Answer Discussion :

Brunnel Ngwanet