Diagnostic Dilemma

Thrombocytopenia, anemia, fever, tender hepatomegaly and gall bladder wall edema


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Question
A 6 years old girl presenting with history of abdominal pain, fever, lethargy and vomiting. On examination she was a very toxic child and had tender hepatomegaly. Her serial CBC shows dropping hemoglobin from 9.5 to 8 gm, dl, also platelets are dropping from 95000 to 85000 to 45000 and finally 35000, cumm. Her SGPT is 56 and 76 done on two different days of hospitalization. She was afebrile in the first 3 days of hospitalization but developed fever upto 102 on 4th day. Her WBC increased from 6000 to 12000, cumm with 78 percent polymorps. Our initial diagnosis was salmonellosis or Dengue hemorrhagic fever.

What is the possible diagnosis_?
Answer Discussion :
R
Rahul Gujarathi
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Most Probably any of these Malaria, Lesmeniasis or Leptospirosis. A bone marrow and liver biopsy will aid in confirmation.
15 years ago
Z
ziad ismiel
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do bone marrow aspirate-may be KALA AZAR andLOOK 4 HEPATITIS SCREEN .WAT ABOUT ABDOMINAL U.S andBD CULTURE
15 years ago

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