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An infant with seizures with positive human herpes virus 6 on multiplex PCR and positive herpes simplex virus 1 on uniplex PCR - How to interpret?

Ramsha Ansari, Aditi Gupta, Zahabiya Nalwalla, Ira Shah

A 6 month old boy presented in May 2024 with fever, cough and cold for 10 days along with generalized tonic clonic convulsions on day 8 of fever followed by excessive irritability and refusal to feed.....

Asymptomatic Congenital Parvovirus infection in a neonate born to an asymptomatic mother with Parvovirus infection in the third trimester - Management issues

Zahabiya Nalwalla, Ramsha Ansari, Tsering Yangchen Dirkhipa, Forum Shah, Amol Pawar, Ira Shah

A 29 year old primigravida (G1P1L0A0) was admitted to the hospital following a spontaneous rupture of membrane at 38 weeks of gestation. Antenatal ultrasound (USG) scan at 30+5 weeks of gestation show....

Cheek cysticercosis - To Treat or Not to Treat

Dhruv Gandhi, Shatakshi Garg, Zahabiya Nalwalla, Balagopal Kurup, Tejas Athalye, Sunita Sharma, Ira Shah

A 14-year-old boy presented with a painless, progressively enlarging right cheek swelling for six months. There was no fever or trauma. He had a mixed dietary pattern. On examination, there was a soli....

Successful Recovery from HHV-6 Encephalitis in an Immunocompetent Child

Vaidehi Mehta, Suhani Jain, Meenakshi Dey, Ira Shah

A 2-year-old female child presented with a 10 day history of persistent fever and an episode of paroxysmal event on the 1st day of illness. Her family history was unremarkable and vaccinations were up....

Discordance Between Xpert MTB/RIF Assay and Line Probe Assay- How to Interpret?

Dhruv Gandhi, Aditi Gupta, Zahabiya Nalwalla, Ira Shah

A 2-year-old boy presented with a progressively enlarging painful swelling over the right cheek for 8 days. It was associated with fever. There was no facial trauma, toothache, dysphagia, neck swellin....

Polymicrobial infection in immunocompromised host - How to manage?

Meenakshi Dey, Suhani Jain, Ira Shah

A 2 year 9 month old male suffering from STAT1 gain of function mutation on whole exome sequencing diagnosed at the age of 6 months in view of recurrent pneumonia presented to us with fever and cough ....

Discordance between mycobacterial tuberculosis whole genome sequencing and phenotypic drug sensitivity - How to interpret

Meenakshi Dey, Suhani Jain, Ira Shah

A 14-year-old female presented in August with complaints of cough, easy fatiguability, shortness of breath for the past 2-3 months. She also had a 6.5 kg weight loss in the past 8 months and no menstr....

Hereditary Spherocytosis with splenectomy in a Pregnant Woman - How to manage the immunizations?

Tsering Yangchen Dirkhipa, Suhani Jain, Meenakshi Dey, Ira Shah

A 38 year old female, G3P1L1A1 at 31+4 weeks of gestation with expected date of delivery in February 2024 and a known case of hereditary spherocytosis with splenectomy done 11 years back in 2012 (at 1....

Interpretation of Cytomegalovirus (CMV) serology

Meenakshi Dey, Suhani Jain, Ira Shah

A 31 year old primigravida at 12 weeks of gestation was referred to us for evaluation based on the results of a TORCH panel. The test indicated that her cytomegalovirus (CMV) IgG level was 280 Au/ml a....

Nocardiosis in an immunocompromised child with peripherally inserted central catheter - how to treat?

Zahabiya Nalwalla, Tsering Yangchen Dirkhipa, Ira Shah, Venkata Rama Mohan Gollamudi

A 12 year old boy was diagnosed as Non-metastatic Ewing’s sarcoma of left scapula in July 2021. He was receiving chemotherapy and a peripherally inserted central catheter (PICC) line was inserted for ....

Hematemesis in a child with beta thalassemia

Himali Meshram

A 14 year old girl presented to us with hematemesis in April 2016. She was diagnosed to have heterozygous HBE thalassemia at the age of 2 years. Since then she was on regular blood transfusions. Her ....

Glycogen Storage Disease - Type 3

Suhani Jain, Ira Shah

A 9-month-old female child was referred for asymptomatic hepatomegaly detected by the local physician. Her birth history was normal and she had achieved milestones as per her age. The child had no fam....

Tuberculous Atlanto-axial dislocation – How to manage?

Suhani Jain, Ira Shah

An 8-year-old girl presented with pain and inability to extend her neck for three months. She had a history of occasional low-grade fever during this period, but she was afebrile at presentation. Ther....

Aberrant vasculature in the Liver

Suhani Jain, Ira Shah

A 2-month-old female infant presented for a secondary assessment following the identification of abnormal vessels during antenatal ultrasound. Subsequent imaging via CT abdomen at 1 month of age revea....

INH Monoresistance tuberculosis with inhA gene resistance - What should be the anti-tuberculosis regimen?

Vaidehi Mehta, Ira Shah

A 4-year-old boy presented with gradually increasing left axillary swelling for 7 months. There is no fever, cough, loss of appetite or weight loss or contact with a patient having tuberculosis (TB) c....

Is it Congenital toxoplasmosis?

Suhani Jain, Ira Shah

A 1 month old male child delivered by lower section cesarean section (LSCS) at 8 ½ months of gestation in view of meconium stained liquor with a birth weight of 2.09 kg was referred in view of a posit....

Recurrent abdominal pain - Diagnostic dilemma

Suhani Jain, Ira Shah

A 6-year-old boy presented with recurrent abdominal pain for 1 ½ years. He had history of soiling of his pants on passing stools on consumption of certain foods such as milk, cookies and chocolates. T....

A 5 years old girl with suspected Celiac disease

Suhani Jain, Ira Shah

A 5 ½ years old girl presented with recurrent diarrhea since 1 year of age. Her stool was watery and the frequency was about 4-5 times/day. She was treated symptomatically with multivitamin and multim....

A 3 months old with pneumonia and positive cytomegalovirus IgM

Suhani Jain, Ira Shah

Problem - A 3 ½ month-old female infant on exclusive breast feeds presented with constipation for 4 days. She had pneumonia 15 days ago which was treated with IV Ceftriaxone and IV amikacin for 7 days....

A mother with bad obstetric history - Is it due to cytomegalovirus?

Suhani Jain, Ira Shah

A 32-year-old pregnant female at 9.5 weeks of gestation presented for ruling out fetal deaths due to intrauterine infection. She has a bad obstetric history with a medical termination of pregnancy (MT....

Is it BCGiosis or disseminated Tuberculosis?

Tsering Yangchen, Ira Shah

An 11 months old girl presented with gradually increasing left axillary swelling for which she underwent an incision & drainage of the pus 1 week ago. Pus wall histology showed granulomatous inflammat....

Salmonella enterica meningitis in a neonate

Suhani Jain, Ira Shah

A 15-day-old boy presented with a complaint of poor feeding and fever for two days. The child was previously alert and was breastfeeding normally since birth. He was born at full term by vaginal deliv....

A child with Budd Chiari syndrome and recurrent thrombosis

Suhani Jain, Ira Shah

A 10-month-old girl presented with ascites. At 3 months of age, she had ascites and was diagnosed to have Budd Chiari syndrome (BCS) due to acute thrombosis of Middle and Right Hepatic veins (MHV and....

Pseudohypoaldosteronism Secondary to Urinary Tract Infection in a Premature Newborn Baby

Samet Benli, Erdal Taşkın, Mustafa Aydın

Upon the detection of sodium 120 mmol/L and potassium 8.8 mmol/L in the routine examinations taken on the 93th day of hospitalization of a premature baby born at the 24th gestational week, weighing 70....

Recurrent Pinworm Infestation

Suhani Jain, Ira Shah

A 6-year-old boy presented with passing recurrent worms in the stool for three years for which he had been treated with multiple courses of anthelminthics in form of albendazole and mebendazole. Add....

Caroli's disease in infancy - A report of 2 cases

Nupur Sanklecha, Aashna Doshi, Ira Shah

A 9-month-old boy born of non consanguineous marriage presented with progressive abdominal distension with prominent abdominal veins since 2 months of age. He was born at full term and had achieved mi....

Tenofovir and Hepatitis B - How to manage?

Yash Sonagra, Ira Shah

Case- A 16 years old girl was referred to us for positive serum HbsAg test. She has acute lymphoblastic leukemia diagnosed at age of nine years for which she received multiple blood transfusions. Her....

A rare cause of chest pain in a teenager - an unlikely diagnosis

Sofia Pimenta, Carolina Fraga, Manuel Ferreira, Leonilde Machado, Margarida Tavares, Joaquim Cunha

A 12-year-old female born in Syria presented to the emergency department with a history of fever and rhinorrhea for the last 2 weeks. She had been prescribed amoxicillin without improvement, and she b....

A case report of minor blood group incompatibility (anti c) in a neonate - Is there a need for routine maternal antibody screening?

S. Nithyalakshmi, P. Kumar, V. Anurekha, K.S. Kumaravel, S. Gobinathan, P. Sampathkumar

A female baby with term delivery and a birth weight of 2 kilograms was born to a 27 years old G2P1L1A0 mother by normal vaginal delivery. There was no history of blood transfusion in the motherand no....

Unilateral breast mass in a newborn

Sofia Pimenta, Teresa Cachada Baptista, João Maria Goudiaby, Fábio Barroso

A female full-term newborn, with 26 days of age, was brought to the Emergency Department for edema and right nipple redness with a 2-day evolution; the mother reported discomfort since that day. Pregn....

Fulminant Hepatic Failure in a Child with Fever and Jaundice

Hasmukh Chapsi Gala

A 7-year-old girl presented with fever for 6 days, jaundice for 5 days, vomiting and loose stools for 2 days and altered sensorium and decreased urine output for 1 day. On admission, her blood pressur....

Biliary peritonitis: Rare presentation of spontaneously ruptured choledochal cyst

Ira Shah

A 6 months old girl presented with diarrhea and vomiting for 10 days and abdominal distension for 1 day along with oliguria. On examination, weight was 6 kg; child was dehydrated and had ascites with ....

The diagnosis of pre-symptomatic diseases

Sofia Pimenta, Sara Soares, Ana Rita Soares, Leonilde Machado

A 4-month-old male child, second child of healthy non-consanguineous parents, with no relevant family history and no prenatal or perinatal complications was referred to a Neurodevelopment clinic due t....

Hyperplastic duodenal and jejunal polyps in a child with portal cavernoma

Amit Dashputra, Ira Shah

A 7-year-old boy presented with abdominal pain for 2 days. He was diagnosed to have extrahepatic portal hypertension with portal cavernoma at the age of 1 year. At that time, he had hematemesis and ma....

Massive Hepatomegaly as a presentation of Chronic Granulomatous Disease

Rhea Vyas, Ira Shah

A 4½-month-old boy, first by birth order, born of a third degree consanguineous marriage, presented at his first immunisation visit with episodes of recurrent diarrhoea for 3 months and hepatomegaly. ....

Recurrent Vomiting

Himali Meshram

A 3.5-year-old male child presented with recurrent episodes of vomiting (non-bilious, small quantity) for two years. There was no loss of weight, no history of abdominal pain or distension, loss of ap....

Tachypnea in a Neonate and Diagnostic Conundrums

Udoka Asoh, Hilary Klonin

A term male infant was born by normal vaginal delivery following an uncomplicated pregnancy. He was admitted to the neonatal intensive care unit (NICU) at 33 hours of age with tachypnea [respiratory r....

Sibling deaths due to infections

Ira Shah

A 6-month-old boy born of second-degree consanguineous marriage presented with diarrhea, papular reddish lesions over hands & feet and chronic bilateral ear discharge since 3 months of age. His eldest....

Knocking Down the Diagnosis in Knock Knees

Anilkumar M Khamkar, Georgeena Elsa Jose, P D Pote, Pradeep Suryawanshi

An 8-year-old girl, born of 2^nd degree consanguineous marriage presented with bilateral lower limb deformity and not gaining height. Other problems included poor scholastic performance, dim....

A Female Child with Recurrent Pneumonia and Webbing of Neck

Senthil Kumar Palaniappan, Thiyagarajan Srinivasan

A 4 years old female child was admitted with hurried breathing for one day, fever with cough and cold for three days. She was admitted thrice previously for pneumonia elsewhere. She underwent closure ....

Acute Donath-Landsteiner Hemolytic Anaemia (DL-HA) in a 5-year old male child - How to treat?

Gautam Araya

A 5-year-old male present to the emergency department with fever for 8 days and acute onset of dark coloured urine. There was no bleeding from any other site. Five days ago, he was prescribed amoxicil....

Differential Diagnostic Challenges During the Covid-19 Pandemic for Pediatricians in an Eastern European Country

Szofia Hajósi-Kalcakosz, Borbála Zsigmond, Andrea Párniczky, Réka Bodnár

A two-year-old girl was admitted to a local hospital in Hungary in March 2020 with fever, difficulty in breathing and one week history of coughing. She had chronic cough, frequent respiratory illnesse....

Serologic Rebound in Congenital Toxoplasmosis

Beatriz Simões Vala, Vânia Leitão Martins, João Patrício de Sousa e Alvim Bismarck do Agro

A male newborn who was the third child of a non-consanguineous couple was referred for further management on the fourth day of life. Asymptomatic toxoplasmosis seroconversion was detected at 21^st....

Acute encephalopathy: What to suspect and how to prevent?

Vinod Kumar Gupta, Vanita Verma, RK Yadav, Mukesh Vir Singh, Anubha Shrivastava

A 9-year-old girl presented with convulsions followed by unconsciousness. She had fever and cough for one week. On examination, Glasgow coma score (GCS) was 8/15. There were no meningeal signs or foca....

Desquamating Rash with Hepatitis

Parminder Kaur, Vipul Gupta, Reena Jain, Shivanjali Sood

A seven-year-old female child presented with fever for 3 days, oral ulcers and rash all over the body for one day. She was on sodium valproate at 20 mg/kg/day since a month in view of focal seizures. ....

Hepatic Encephalopathy due to Hepatitis A – Can age predict need for liver transplant?

Kruti Dhaval Gandhi, Ira Shah

Case 1 An 8-year-old female child presented with fever and lethargy for 8 days, right hypochondriac pain and abdominal distension for 5 days, vomiting for 3 days, oliguria and irrelevant speec....

Pink Hematuria in an Infant

Mohammed Azar, Aryn Jaitley

An 8 months old girl born of non-consanguineous marriage presented with two weeks history of bright blood spotting in her nappy. These episodes were intermittent with 3-4 episodes per week with multip....

Itching for an Answer: Managing a Recurrent Evolving Annular Rash in a Teen Girl

Benjamin N. Africk, Bridget Boyd

A 13-year-old female with a history of atopy presented with a recurrent and worsening skin rash for 2 months (Figure 1). Around age 3 years, she developed a scaly, pink patch in the shape of a heart o....

Recurrent Hyperbilirubinemia in an Infant

Pawan Daga, Ira Shah

A 7-month-old boy was referred for recurrent indirect hyperbilirubinemia since day 6 of life. The child had received phototherapy twice for same in neonatal period. He was also on phenobarbitone. When....

Massive Hepatomegaly - Can it be acute lymphoid leukemia?

Himali Meshram, Ira Shah

A 9 years old female child presented to our Pediatric Liver clinic with a loss of weight of 2.5 kgs in 6 months, abdominal distension and loss of appetite for 3 months. There was no fever, bleeding ma....

Persistent Diarrhea in an Infant- Could it be Enteroaggregative Escherichia coli

Himali Meshram, Ira Shah

A one and half month-old male child born of non-consanguineous marriage presented in September 2017 with diarrhea for 20 days. He had 20-25 motions per day associated with occasional vomiting. Antenat....

Hyperbilirubinemia in a child on anti-retroviral therapy

Pawan Daga, Ira Shah

A 20 years old HIV infected girl on anti-retroviral therapy (ART) since the age of 12 years presented with jaundice for 3 months. There was no fever. She was initially on stavudine (d4T), lamivudine (....

Familial Tubercular Abscesses

Shweta Bargaje, Ira Shah

A 13-month-old boy presented with an abscess over the right thigh following measles vaccine. The abscess was drained and histopathology of the abscess wall showed non-caseating granulomatous inflammat....

A 9 months old child with Asymptomatic Bradycardia

Pritika Mall, Ira Shah

A 9-month old boy, born of a non-consanguineous marriage was referred for bradycardia. The child was otherwise asymptomatic. On examination, his heart rate was 60 bpm, with no apex pulse deficit. Othe....

Fever and Rash, Not always Viral Exanthem

Stacey Ulrich, Peter Chiraseveenuprapund

A 7 years old previously healthy female presented to the emergency department for facial and truncal rash, facial swelling, and fever to 102°F which started 2 weeks prior. Patient also reported sore t....

Indirect Hyperbilirubinemia in a Toddler

Apurva Shrigiriwar, Ira Shah

A 1½ years old boy born of non-consanguineous marriage presented with jaundice and clay-colored stools since day 3 of life. There was no itching but there were clay stools and pale urine. The chi....

The target joint in Severe Hemophilia A

Govind Kendre, Sunil Hilalpure, Shruti Mantri, Suraj Goyanka, Leo Prince, Murlidharan C

A 12-years-old-boy presented with recurrent left knee joint swelling for 6 months. He was diagnosed to have severe hemophilia A at the age of one year when he was evaluated for multiple ecchymoses ove....

Starry Sky Intracranial Granulomas with Spinal Granulomas

Tsering Yangchen, Ira Shah

An 8 years old female, presented in Feb 2015 with fever and headache for 15 days. She was admitted in a hospital a week ago after she developed right lateral rectus palsy. There was no contact with a ....

A Queer Case of Thrombocytopenia in a Child

Govind Kendre, Shruti Mantri, Sunil Hilalpure, Suraj Goyanka, Leo Prince, Murlidharan C

A 3-years-old male child was hospitalized for right-sided pneumonia. Complete blood count (CBC) showed hemoglobin 13.5 gm/dl, total leucocyte count- 6800 cells/cumm and thrombocytopenia with a platele....

Is it Ehlers Danlos syndrome or Osteogenesis Imperfecta?

Devi Bavishi, Ira Shah, Ashok Johari

A two and a half years old female, born of a non-consanguineous marriage presented in August 2011 with multiple fractures affecting all limbs since the age of nine months. She had 36 fractures till da....

Crohn's disease or intestinal tuberculosis: A diagnostic dilemma

Amit Dashputra, Ira Shah

A 12-year-old boy presented with pain in the abdomen for 5 months and a weight loss of 18 kg in the same period. He used to pass non-bloody loose stools with mucus 2-3 times a day. The examination sho....

Growth of Mycobacterium tuberculosis (MTB) on Sputum Culture in an Asymptomatic Child

Amit Dashputra, Ira Shah

A 6-year-old female was referred to us for evaluation of incidentally discovered right-sided cervical lymphadenopathy for one month. She had a cough initially for a week but now did not have any compl....

Fever with rash over palms and soles along with hepatomegaly - Can it be parvovirus infection?

Amit Dashputra, Ira Shah

A 4-year-old female presented with fever for 5 days. She had red eyes along with fever for the initial 2 days. Subsequently, she developed rash over palms and soles after 2 days of fever, which had re....

Early-infancy Osteoarticular Infection: A Case Report

Barbara Minkowitz, Jennifer R Ristic, Robyn Murphy, Elizabeth Baorto, Emily Lillie

A previously healthy 4-month old boy was admitted with 5 days of fever, irritability and decreased feeding. He was evaluated by the pediatrician and emergency department. Blood cultures were positive ....

Non-Tuberculous Mycobacterial Infection in a child operated for Appendectomy

Lavina Desai, Tushar Garg, Ira Shah

A 12-year-old boy presented in November 2013 with abdominal pain and vomiting. He was operated for acute appendicitis with a perforation 5 months ago. His current CT scan abdomen showed a short segmen....

Is it Chronic Hepatitis A infection?

Lavina Desai, Ira Shah

A 5 year old boy presented in August 2015 with jaundice and decreased appetite for 2 months. He had been investigated by his pediatrician and found to have hepatitis. In view of non-improvement, he wa....

Is it Congenital Toxoplasmosis?

Lavina Desai, Ira Shah

A 15 day old boy was referred in April 2016 to rule out congenital toxoplasmosis. His mother’s obstetric history was complicated with loss of the first pregnancy at 8 months due to still birth, loss o....

An Infant with Fever, Raised Inflammatory Makers and No Apparent Focus for Fever

Kollannoor B, Roberts M, Abdelaziz M

A 4 month old male infant presented with fever for 4 days. He had no localizing signs on examination. He was irritable and suspected to have meningitis. Investigations showed white blood cells 28,100/....

Tuberculous Pleural Effusion- Residual Pleural Thickening

Lavina Desai, Ira Shah

A 7 year old girl presented with fever for one month. Father had been treated for pulmonary tuberculosis (TB) 6 months ago. She was detected to have right sided pleural effusion with pneumonia on ches....

Musculoskeletal Cysticercosis

Lavina Desai, Ira Shah

A 23 year old female was referred to us in April 2016 with right shoulder swelling for 3 months. In January 2015 she had fever and right axillary lymphadenopathy and was diagnosed to have right forear....

Persistent Pseudomonas Aeruginosa Infection in a child with Cystic Fibrosis – How to manage?

Lavina Desai, Ira Shah

A 6 month old girl was diagnosed to have cystic fibrosis (CF) in 2009 in view of recurrent respiratory tract infections and diarrhea with malnutrition. Sweat chloride conductivity test was positive (7....

Is it Gaucher’s Disease or Niemann-Pick’s disease?

Lavina Desai, Ira Shah

A three and a half-year-old girl, currently bedridden, presented in 2013 with progressive loss of milestones from two years of age. On examination she showed poor oral hygiene, oral thrush over the ha....

Right Lung Opacification – What is the diagnosis?

Ilechukwu GC, Kollannoor B, Abdulaziz M.

A previously well, 7 week old baby presented to the paediatrics accident and emergency unit with a history of cough and fast breathing of one week duration associated with reduced oral intake of <50%.....

Staphylococcus Aureus Infection and Internal Jugular Vein Thrombophlebitis

Shakil Shaikh, Vijay Raut, Ira Shah

Case Report: A 10 month old male child was referred in view of fever, anasarca and respiratory distress. He was treated with ceftriaxone by referring hospital for 3 days. On presentation to us, he had....

Infantile Hemangioendothelioma - How to treat?

Amit Dey, Ira Shah

A 1 months old boy presented with progressive abdominal distension since 1 month of age and breathlessness for a day. There was no jaundice or pallor. On examination, weight was 3.86 kg. His vital par....

Jaundice with triangular facies and pulmonary stenosis

Aditi Joshi, Ira Shah

A 2½ years old girl born of third degree consanguineous marriage presented with progressive abdominal distension for one and a half months along with jaundice at onset. There was no bleeding manifesta....

Interstitial Pneumonia and Cytomegalovirus Infection in a 2 month old Child

Dr Ira Shah, Drishti Tolani

A 2 month old girl presented with cough and breathlessness. She was ventilated and detected to have bilateral interstitial pneumonia along with hypoglycemia. Her liver function tests were also abnorma....

Lower motor neuron facial palsy in CNS tuberculomas

Dr Ira Shah, Drishti Tolani

An 8 years old boy presented with fever for 19 days with left sided upper limb monoparesis and left lower motor neuron (LMN) facial palsy for 1 day. Cerebrospinal fluid (CSF) showed 25 mg/dl proteins,....

Continued Neurological Damage in HIV Infected Despite Antiretroviral Therapy

Dr Ira Shah, Drishti Tolani

A 13 years old HIV infected boy on ART since 6 years of age presented with progressive increase of involuntary movements of left side of body with increased tone in Sept 2011. He was diagnosed to have....

Granulomas in Chronic Granulomatous Disease

Dr Ira Shah, Anmol Goyal

A 3 years old boy suffering from chronic granulomatous disease (CGD) presented with fever and cough. He was detected to have CGD at the age of 1 year 4 months in view of persistent pneumonia and a pos....

Acute Liver Failure due to acetaminophen toxicity - How to treat?

Dr Ira Shah, Parth Gada

A 21 months old boy presented with fever, cough, cold for 4 days, drowsiness for 2 days and one episode of convulsion. He had been treated with oral paracetamol for the initial 2 days of fever every 4....

Refractory Iron Deficiency Anemia

Minhajuddin Ahmed, Shweta Goyal, Shweta Anand

A 10-year-old male child came to our out-patient department (OPD) for evaluation of refractory anemia. He had received adequate dietary and oral iron supplementation but still required multiple blood ....

Dermal swellings, joint contractures but no gingival hypertrophy

Dr Ira Shah

An 18 month old girl born of third degree consanguineous marriage presented with gradual restriction of movements in both the limbs for 6 months. Patient had flexion contractures of both ankles, knees....

Neonatal cholestasis in an infant with Rh incompatibility

Dr Ira Shah

A 1 ½ months old boy was referred for jaundice with clay stools since birth. There was history of Rh incompatibility which led to jaundice in neonatal period that required phototherapy and exchange tr....

Recent Conversion of Tuberculin Skin Test

Dr Ira Shah

A 5 year old girl weighing 14kgs was referred in view of positive Tuberculin skin test {TST} {15mm by 2 TU} in November 2015. She had been tested as she had fever for 3 days but was currently asymptom....

Chronic diarrhea with fever

Dr Ira Shah

A 1 years old boy born of non-consanguineous marriage presented with recurrent watery, foul smelling diarrhea and fever for 2 months. He was treated with antibiotics, steroids and lactose free milk. H....

Multiple ulcers in the terminal ileum

Dr Ira Shah

A 16 years old boy presented with abdominal pain and intermittent low grade fever for 3-4 months. An ultrasound {USG} abdomen showed multiple lymphnodes with bowel wall thickening of ascending colon, ....

Duodenal and Jejunal Polyps in Extra-hepatic Portal Hypertension

Dr Ira Shah

A 7 years old boy suffering from extrahepatic portal hypertension had an episode of malena. An upper GI endoscopy was done. There was presence of Grade 1-2 esophageal varices without any bleeding stig....

Hodgkin’s Lymphoma with Tuberculosis

Dr Ira Shah

A 12 years old boy presented with evening rise of fever for 4-5 months, bilateral otorrhoea for 1 month and loss of appetite. He was treated for cervical tuberculous lymphadenopathy 3 years ago and to....

Splenectomy without Prior Vaccination

Dr Ira Shah

A 9 years old boy presented with pain in left part of abdomen since days. There was no fever or trauma. On examination, vital parameters were normal. There was firm splenomegaly. Other systems were no....

Demyelination in tuberculous meningitis

Dr Ira Shah

A 7 years old girl presented with fever for 15 days, and 1 episode of generalised tonic clonic convulsion followed by loss of consciousness. Her sister was suffering from fibrocavitatory TB and was on....

Fever, jaundice with emerging pancytopenia

Dr Ira Shah

A 7 year old boy born of non-consanguineous marriage presented with fever with chills for 10 days. He had left flank pain and bilateral painful knees along with fever. There was one episode of uprolli....

Nutritional Hypovitaminosis D Presenting as Tetany in an Infant

Dr Ira Shah

A 12 months-old boy presented with vomiting, diarrhoea and carpopedal spasm. He was exclusively breast-fed till 6 months of age and was on full diet now. On examination, he had fronto-parietal bossing....

Fatty liver in Familial Hyperlipidemia

Dr Ira Shah

A 2 years old girl presented with fever for 3 days. Father had hypercholesterolemia with multiple xanthomas, mother was on thyroid supplements. Child was detected to have atrial septal defect {ASD} in....

Poor scholastic Performance in an HIV infected girl

Dr Ira Shah

A 10 years old HIV infected girl on anti-retroviral therapy {ART} consisting of zidovudine {AZT}, lamivudine {3TC} and nevirapine {NVP} for 5 years presented with poor scholastic performance. As per t....

Hyperlipidemia in an HIV infected child on anti-retroviral therapy

Dr Ira Shah

A 9 years old boy was detected to be HIV infected in October 2014 in view of right otitis media with mastoiditis causing focal cerebritis. After treatment of this infection, his CD4 count was done whi....

Congenital Hydrocephalus: Communicating or Obstructive_?

Jogender Kumar, Amitabh Singh

A two-month-old boy presented with irritability, recurrent episodes of projectile vomiting for 3 days and rapidly increasing head size for 15 days. There was no fever. He was born at term and had a bi....

Hydrocephalus in tuberculous meningitis

Dr Ira Shah

A 4 years old girl was referred as she had been on antituberculous therapy {ATT} for past 2 years 8 months. At age of 1 year 4 months, she was diagnosed as tuberculous meningitis {TBM} with hydrocepha....

How to treat congenital syphilis when aqueous penicillin is not available_?

Dr Ira Shah

A 3 days old baby is diagnosed to have congenital syphilis on testing with VDRL. The child is asymptomatic and had normal birth with birth weight of 3kg. Cerebrospinal fluid {CSF} VDRL is negative. In....

Space occupying lesion in the brain– What is it_?

Dr Ira Shah

A 7 years old boy presented with fever and headache for 1 month, projectile vomiting for 15 days and altered sensorium for 1 day. There was no contact with a patient having tuberculosis. On examinatio....

Tuberculous Meningitis with Occlusion of Middle Cerebral Artery

Dr Ira Shah

A 7 month old girl was diagnosed as tuberculous meningitis {TBM} with hydrocephalus in April 2011 in view of fever for 15 days and convulsions. She was started on 4 drug antituberculous therapy {ATT} ....

EXTRAHEPATIC PORTAL VEIN OBSTRUCTION WITH HOMOCYSTINURIA

Dr Ira Shah

A 2½ year old boy presented with abdominal distension for 2 years. This was preceded by episode of vomiting that required hospitalization and intravenous fluids for 8-10 days. There was no hematemesis....

SPUTUM POSITIVE MILIARY TB IN A CHILD WITH DOWN’S SYNDROME

Dr Ira Shah

A 13 years old boy with Down’s syndrome presented with intermittent evening rise of temperature for past 2 months associated with productive cough. He had lost 4 kg weight in the same time and had los....

Tuberculous Peritonitis with pleural effusion

Dr Ira Shah

A 12 years old girl presented with fever and abdominal distension. There was no contact with TB. She was detected to have left sided pleural effusion with ascites. Chest X-Ray showed left pleural effu....

When to stop Penicillamine in Wilson`s disease_?

Dr Ira Shah

A 5 years old boy was diagnosed as Wilson’s disease at the age of 4½ years in view of hepatitis with jaundice, increased copper content in liver {132 µg, gm} and elevated urine copper {643}. His ophth....

INDIRECT HYPERBILIRUBINEMIA

Dr Ira Shah

A 3 years old boy presented with persistent indirect jaundice since 1 month of life. At 4 months of age he was detected to have involuntary movements with developmental delay. MRI brain showed hypomye....

Recurrent tuberculosis

Dr Ira Shah

A 2 years 3 months old boy presented with recurrent tuberculosis since 1 month of age. He was born at term and had meconium aspiration and required neonatal intensive care stay for 6 days. At 1 month ....

Paradoxical Adenopathy in a Child with Tuberculosis

Dr Ira Shah

A 13½ years old girl suffering from tuberculosis {TB} presented with clinical deterioration. She was diagnosed as having tuberculous mediastinal adenopathy 7 months ago and was started on antitubercul....

Elevated serum bile acids in a child with liver disease

Dr Ira Shah

A 2½ years old girl presented with generalized itching since 8 months of age. There was no history of jaundice. Her milestones were appropriate for age. On examination, weight was 9.4 kg, height was 8....

Biliary Atresia with Congenital Anomalies

Dr Ira Shah

A 1½ month old girl born of non consanguineous marriage presented with jaundice and clay colored stools since birth. On examination, she had cleft lip and palate with jaundice and hepatomegaly. Invest....

Galactosemia

Dr Ira Shah

A 3½ months old boy born of non-consanguineous marriage presented with abdominal distension for 8 days, jaundice and ecchymoses over trunk for 1 day. There was no clay coloured stools or fever. He was....

Rifampicin Induced Hepatitis

Dr Ira Shah

A 2½ years old boy had fever for 6-7 days for which Mantoux test was done which was 10 x 15 mm. Chest X-Ray was suggestive of primary complex. He was started on 3 drugs anti TB treatment {ATT} consist....

Pre-extensive drug resistant {XDR} Tuberculosis

Dr Ira Shah

A 14 years old girl presented with low grade fever for 8 months along with loss of weight and appetite. She had received 3 drug antituberculous therapy {ATT} 2 years ago for 6 months in view of positi....

Is it tyrosinemia_?

Dr Ira Shah

A 2½ years old boy born of third degree consanguineous marriage presented with bulky frothy stools for 6 months and low hemoglobin, abdominal distension for 4 months for which he had received a blood ....

Ring enhancing lesion in brain and decreasing interferon gamma release assay response

Dr Ira Shah

A 14 years old boy had recurrent right focal convulsions for past 3 years. MRI brain in December 2013 showed neurocysticercosis stage II in left high parietal region for which he was treated with albe....

Cutaneous tuberculosis

Dr Ira Shah

A 3 years old boy presented in December 2014 with reddish patch of 1 cm diameter over left cheek for the past 1½ years. He had been to various dermatologists for the same but had no relief. A biopsy d....

Yellow Skin

Dr Ira Shah

A 9 years old girl presented with yellowish skin for 15 days without high colored urine. She also had fever, rash and yellow skin 3 months ago. She had neonatal hyperbilirubinemia at 1½ months of age.....

Wilm`s Tumor

Dr Ira Shah

A 9 month old boy was referred for jaundice. He was diagnosed to have right sided Wilm`s tumor at 6 months of age and underwent right sided nephrectomy. He was subsequently on chemotherapy of vincrist....

Pulmonary Tuberculosis and Hepatitis

Dr Ira Shah

A 5½ years old girl presented with fever, jaundice and loss of appetite for 4 days. She was antituberculous therapy {ATT} consisting of Isoniazid {H} and Rifampicin {R} for past 10 months of view of p....

Fever, Pancytopenia, Hepatitis

Dr Ira Shah

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 du....

Fever with rash

Dr Ira Shah

A 1½ year old girl presented with fever for 15 days and erythematous rash 12 days ago that lasted for 5 days. There is no cough, vomiting, loose motions or altered sensorium. She was treated with mult....

Neonatal Cholestasis

Dr Ira Shah

An 8 months old boy born of non consanguineous marriage presented with jaundice, yellow urine and clay stools since day 6 of life. On examination, he had rickets, weight was 6.2 kg, He had jaundice wi....

Budd Chiari Syndrome

Dr Ira Shah

A 3 months old girl presented with ascitis. There is no jaundice. Ultrasound abdomen with colour doppler showed ascitis with hepatomegaly with non-visualisation of hepatic veins. CT angiography showed....

Antiretroviral therapy – Switch of therapy

Dr Ira Shah

A 6 years old HIV infected boy was referred for further management. He was on antituberculous therapy {ATT} for past 2 months in view of pulmonary TB and father having died of TB 8 months ago. His CD4....

Recurrent ketotic hypoglycemia

Dr Ira Shah

A 4 years old boy presented with recurrent ketotic hypoglycemic convulsions at 1½, 3½ and 4 years of age. Currently on examination, he was detected to have hepatomegaly {liver 2cm palpable with span 7....

Biliary Ascariasis

Dr Ira Shah

A 7 years old boy presented with fever and right hypochondriac abdominal pain for a 1 month. There was no vomiting or jaundice. He underwent an ultrasound {USG} abdomen that showed edematous common bi....

Bilious Ascites

Dr Ira Shah

A 6 months old girl presented with diarrhea and vomiting for 10 days and abdominal distension for 1 day. There was no edema elsewhere. There is history of clay stools. On examination, she was jaundice....

Jaundice in a child with leukemia

Dr Ira Shah

A 13 years old child presented with fever for 15 days along with jaundice. He was admitted in a hospital and detected to have pancytopenia. His Hepatitis A, B and E markers were negative. He underwent....

Tachyarrhythmia in a congenital heart disease

Dr Ira Shah

A 6 months old boy presented in the emergency with excessive crying. He had cough, cold for 2 days and received some medications for the same. There was no fever. On examination, he had a heart rate o....

SUB CARINAL LYMPHADENOPATHY

Dr Ira Shah

A 1½ years old presented with recurrent episodes of cough since 4 months of age. He was hospitalized 4 times. First admission – at 4 months of age for LRTI. Treated with antibiotics for 7 days. Echoca....

BILIARY ATRESIA

Dr Ira Shah

A 5 months old girl presented with jaundice, high coloured urine and clay coloured stools since birth. There was no fever or rash in mother during pregnancy. On examination, child was well grown, had ....

Recurrent diarrhea with failure to thrive

Dr Ira Shah

A 15 month old boy born of non consanguineous marriage presented with recurrent diarrhea and failure to thrive since 1 month of age. The stools are semi-loose with mucus 8-10 times, day with 2 episode....

2 year old with chronic pneumonia

Dr Ira Shah

A 2 year old girl born of third degree consanguineous marriage presented with fever, cough and breathlessness since 3 months. She had been treated for same with multiple antibiotics but had no respons....

A 2 month old with cough since birth

Dr Ira Shah

A 2 month old boy born of non consanguineous marriage presented with cough since birth, fever and breathlessness for 4 days. There is no refusal of feeds, difficulty in feeding. There is no stridor.

Chronic joint swellings

Dr Ira Shah

A 3½ years old boy presented with fever and cough 3½ months back following which cough subsided with treatment. After 15 days of onset of fever he developed pain and swelling in left knee joint which ....

Encephalopathy

Dr Ira Shah

A 10 month old boy born of non consanguineous marriage presented with fever for 5 days, refusal of feeds for 3 days and drowsiness for 1 day. On examination, vital parameters were normal. He had pallo....

CATARACTS

Dr Ira Shah

A 3 year old male child born of non consanguineous marriage presented with bilateral cataracts since 10 months. Birth history and milestones were normal. There was no jaundice, failure to thrive or dy....

HEMOPHILIA

Dr Ira Shah

A 10 years old boy who is a diagnosed case of hemophilia {Factor VIII levels Less than 1 percent} not on regular Factor VIII therapy presented with abdominal pain and black stools since 1 day. There....

Microphthalmia, Microcornea, Low set ears

Dr Ira Shah

A 4 year old girl presented with recurrent seizures since 1 year of age which are generalized tonic clonic convulsions with clenching occurring once in 2-3 months. Mother had appendicitis in first tri....

Fever, cough, convulsion and hepatosplenomegaly

Dr Ira Shah

A 4½ months old boy born of non consanguineous marriage presented with fever and cough for 15 days. He was treated with IV antibiotics and nebulization for same. He also had an episode of uprolling of....

A 3 year old girl with chronic diarrhea

Dr Ira Shah

A 3 year old girl born of non-consanguineous marriage presented with watery diarrhea since 1 month. The diarrhea initially was blood stained and then foul smelling, greasy with a frequency of 12-15 ti....

EXPOSURE TO XDR-TB

Dr Ira Shah

A 3½ years old girl is in contact with an adult suffering from XDR-TB. Her Mantoux test is also positive. She is otherwise asymptomatic. Her Chest X-Ray is normal

Cytomegalovirus infection and hepatitis

Dr Ira Shah

A 4 month old boy, 2nd born of third degree consanguineous marriage presented with not gaining weight since birth. He was a full term normal delivery with birth weight of 3 kg. Mother had fever at 7-8....

Jaundice and pulmonary stenosis

Dr Ira Shah

A 2½ years old child born of third degree consanguineous marriage presented with gradual abdominal distension and jaundice since 1½ months. She was seen by a physician 1½ months back and treated with ....

HOW DID THE CHILD GET HIV_?

Dr Ira Shah

A 7 years old boy born to a commercial sex worker was referred by an orphanage for HIV testing. Both parents had abandoned the child and the child was living in the orphanage for the past 2 years. His....

THROMBOCYTOPENIA IN AN HIV INFECTED CHILD

Dr Ira Shah

An 18 months old HIV infected boy on antituberculous therapy {ATT} had persistent thrombocytopenia. He had failure to thrive {height 71 cm, weight = 7 kg} with delayed milestones and hepatosplenomegal....

Hematemesis and malena

Dr Ira Shah

A 3 years old boy born of non consanguineous marriage presented with hematemesis and malena 1 year ago and again with malena 6 months ago for which child required blood transfusion. There is no jaundi....

Nucleoside Reverse Transcriptase Inhibitor Combinations

Dr Ira Shah

A 12 years old HIV infected orphan was referred for further management. Both parents were also HIV infected and had died due to same. At 3 years, the child had PCP pneumonia. At 4 years, he was treate....

Posterior Cervical Adenopathy

Dr Ira Shah

A 12 years old girl presented with recurrent bilateral posterior cervical adenopathy 5 mm in size, mobile, non tender since past 5 years. There is no otorrhoea, recurrent cough, cold or dental caries.....

Positive Tuberculin and Quantiferon Gold test

Dr Ira Shah

A 7 years old boy presented with dry cough for 1 month which subsided since last one week. There is no fever, loss of appetite or loss of weight. There is contact with a neighbor who is suffering from....

Drooling of saliva

Dr Ira Shah

An 11 years old give presented with unsteadiness while walking for 1 year, change in voice and dribbling of saliva since 6 months. There is no neuroregression.

Ascitis

Dr Ira Shah

A 12 years old boy presented with progressive abdominal distension since 8 months and edema feet for 1 week. There is no jaundice, bleeding from any site or fever. He was treated with antituberculous ....

A 14 months old boy with sudden onset paraplegia

Dr Ira Shah

A 14 months old boy born of third degree consanguineous marriage presents with sudden inability to stand or sit since 15 days. There is no restriction of movement in upper limb. There is no convulsion....

Herpes zoster

Dr Ira Shah

A 9 year old boy born of non consanguineous marriage presented with herpes zoster over left hand since 5 days. He had renal calculi at 5 years of age. He had no other problems since then. Mother had d....

A 10 month old with recurrent infections

Dr Ira Shah

A 10 month old girl born of non consanguineous marriage presented with not gaining weight, recurrent loose motions and fever since 3 months of age. She has been treated for the same several times but ....

Thrombocytopenia in an infant

Dr Ira Shah

A 4½ month old boy born of 3rd degree consanguineous marriage presented with intermittent fever and gradual distension of abdomen since 2 months and self limited oral ulcers 7 days back. He was an ele....

Pneumonia with positive tuberculin test

Dr Ira Shah

A 2 year old girl presented with fever, cough and cold since 4 days. There was no refusal of feeds, loss of appetite. She had received 6 months of antituberculous therapy 1 year back in view of Pulmon....

HIV and viral load

Dr Ira Shah

A 9 years old HIV infected boy was referred for further management. He had been tested for HIV as his brother was HIV infected. The patient was currently asymptomatic and CD4 count was 1078 {30.5 perc....

Arrhythmia

Sachin G Damke, Tushar Jagzape, Siddharth Kulkarni, Bhavana Lakhkar

A 12 years old child, a diagnosed case of Rheumatic heart disease with mitral regurgitation with mitral stenosis with mild pulmonary hypertension presented to us with increasing breathlessness since 8....

Allergy to Sulpha

Dr Ira Shah

An 18 months old child presented with pulmonary TB and HIV disease. He had failure to thrive {height = 71 cm, weight = 7 kg} with delayed development and hepatosplenomegaly. He was started on TMP-SMX ....

Excessive sleepiness

Dr Ira Shah

A 15 month old girl born of non consanguineous marriage presented with excessive sleepiness for 3 days and fever for 1 day. She had a boil over left lower abdomen 8 days back which has ruptured and le....

Pneumonia with wheeze

Dr Ira Shah

A 10 months old boy presented with cough for 7 days, fever for 3 days and breathlessness for 2 days. On examination, he was in distress with respiratory rate of 60, min, had suprasternal, intercostals....

Malaria treatment

Dr Ira Shah

A 10 years old boy born of non consanguineous marriage presented with fever with chills, pain in right hypochondriac region since 10 days and diarrhea since 3 days. There is no history of jaundice, bl....

Rash

Dr Ira Shah

An 11 year old HIV infected girl on 3 drugs ART consisting of Zidovudine {AZT}, Lamivudine {3TC} and Efavirenz {EFV} since past 1 year presented with generalized swelling all over body with itching an....

Vomiting with Ventricular Septal Defect

Dr Ira Shah

A 6 month old boy with congenital moderate ventricular septal defect {VSD} on decongestive measures consisting of frusemide and digoxin presented with irritability, vomiting and oliguria since 2 days.....

Pneumonia in a 4 month old

Dr Ira Shah

A 4-month-old boy presented with fever, cough, cold since 5 days and breathlessness since 1 day with decreased appetite. He was a full term normal delivery without antenatal or postnatal complications....

INDIRECT HYPERBILIRUBINEMIA

Dr Ira Shah

A 2 month old boy presented with jaundice without high coloured urine since 1 month of age. He was a full term, caesarean section delivery in view of fetal distress with birth weight of 3.5 kg and cri....

Dengue Fluids

Dr Ira Shah

A 2 years old boy presented with fever for 7 days, vomiting for 2 days, pain in abdomen for 2 days and oliguria for a day. There was no jaundice, loose motions or altered sensorium. On examination, th....

Anemia, Rickets and Recurrent Diarrhea

Dr Ira Shah

A 2 and a half years old boy presented with abdominal distension and recurrent diarrhea for 6 months. Stools were frothy and had oil droplets. He also had a blood transfusion 2 month ago. At that time....

Poliomyelitis

Dr Ira Shah

A one and half year old unimmunized boy developed sudden onset lower limb weakness 2 months ago. On examination, he had hypotonia, weakness more in extensors of the calves, bilateral foot drop and abs....

A 6 year girl with recurrent encephalopathy

Dr Ira Shah

A 6 years old girl born of non consanguineous marriage presented with projectile vomiting since 1 day followed by irrelevant speech, rowdy behavior and uprolling of eyes and clenching of teeth 8-10 ti....

When to start antiretroviral therapy_?

Dr Ira Shah

An 8 years old HIV infected boy was referred for further management. At the age of 6 years, he was diagnosed to have Immune Thrombocytopenic Purpura {ITP} with platelet count of 8000, cumm and purpura....

Accidental Leg Injury in an active toddler

Jane Cox

Case: “Barrett was running across the sofa when he took a dive off pretending to be Superman. I managed to catch him by the ankle as he went past. Now he is crying so hard and I am afraid that his leg....

A 3 and a half years old girl with recurrent pneumothorax

Dr Ira Shah

A 3½ years old girl presented with fever and cough since 15 days, breathlessness since 10 days and altered sensorium since 1 day. She was treated for the same with intravenous antibiotics but had no i....

WHAT IS THE CAUSE OF CHOREOATHETOSIS _?

Dr Ira Shah

A 12 years old HIV infected boy presented with sudden onset left sided choreoathetoid movements which have remained same for past 4 months. There was no fever, headache, vomiting, seizures or altered ....

CMV infection

Dr Ira Shah

Case Report: - A pregnant woman at 8 months gestation underwent a regular antenatal ultrasound where it was found that the fetus had mild ventriculomegaly. She then underwent a malformation scan and i....

Fever, rash and convulsions

Dr Ira Shah

Case Report: A two and a half years old boy born of third degree consanguineous marriage presented with fever for 6 days and maculopapular rash starting from face and then spreading to rest of the bod....

Holi colour inhalation

Dr Ira Shah

A 10 years old boy presented with accidental inhalation and ingestion of golden metallic coloured powder during Holi festival followed by difficulty in breathing within 10 minutes of the episode assoc....

Six month old with pallor

Dr Ira Shah

A 6 month old boy born of non consanguineous marriage presented with increasing pallor for 2 months and abdominal lump noticed 5 days back. There was no fever. The child is 3rd of three siblings and o....

Extrahepatic portal hypertension

Dr Ira Shah

Case Report:- A 12 year old body born of non consanguineous marriage presented with hematemesis. Oesophageogastroscopy {OGDscopy} showed portal hypertension. Liver functions were normal. Colour Dopple....

Clay Coloured Stools

Dr Ira Shah

Case: - A 3 month old child presented with clay coloured stools since birth and jaundice with increased sleepiness noticed since past 2 days. On examination, child had jaundice with hepatic encephalop....

Early morning seizures

Dr Ira Shah

A 3½ years old boy born of non consanguineous marriage presented with 3 episodes of hypoglycemia. First episode of hypoglycemia was at 2½ years of age with early morning seizure. Second episode was 20....

Lymphoma

Dr Ira Shah

A 4 year old girl presented with fever and bilateral huge cervical adenopathy since 20 days. A biopsy of the lymph node revealed Non-Hodgkin’s lymphoma. She was started on chemotherapy and the lymph n....

Syncope

Dr Ira Shah

Case : A 12 year old boy presented with 3 episodes of giddiness followed up fainting in last 6 months. All episodes occurred while exercise or playing and the child would remain unconscious for 2 hour....

Anemia in a 6 months old

Dr Ira Shah

Case Report: - A 6 month old male child presented with progressive pallor noticed by parents for the past two months and dark coloured stools for past 1 month. For the above complaints, child was show....

Slurred speech with walking difficulty

Dr Ira Shah

Case Report: - A 6 year old girl born of non consanguineous marriage presented with gradual difficulty in getting up and difficulty in walking. There was no fever, altered sensorium, change in higher ....

Heart Disease

Dr Ira Shah

An 8 month old girl born of non consanguineous marriage presented with not gaining weight since 4 months, fever and cough for 7 days, breathlessness and suck rest suck cycle for 5 days along with exce....

Waddling Gait

Dr Ira Shah

A 2 year old boy born of non consanguineous marriage presented with complaints of not walking properly. He achieved normal milestones. These were no frequent falls or any neurological insult or trauma....

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