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Posted On : 28 Jun 2015

I have a patient age 13 yrs having off and on fever for last 50 days. dry cough for last 10 days.on examination he is having firm spleen palpable. hb 11.8,esr 50 mm..tlcand dlc wnl..widal negative..ps for mp neg,,MP card test neg..usg abdomen showed only spleno megaly,,CXR-NAD,,HE HAS TAKEN TAB Cefixime plustAB Ofloxacin FOR 10 DAYS,, TAB CHLOROQUIN,, TAB PYRA FIN..PATIENT REMAIN NORMAL FOR FEW DAYS AGAIN FVER START COMING SOME TIME IT SHOOTS TO 103..TLC and DLC ARE WNL ON TWO OCCASION..ESR IS ONLY 50mm, HR can u suggest what could be the conditions where tlc and dlc remain normal and fevr persist_?

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Answer 1

There are various differential diagnosis to your child’s condition that need to be considered and investigated.

1.Enteric fever-. Recent studies indicate that it can present with fever, splenomegaly and low to normal leucocyte counts. WIDAL test is inconclusive and not reliable. Do a culture, if possible from bone marrow, if not then blood culture. Treat him with iv Ceftriaxone for 14 days. or oral azithromycin.

2.Another d, d could be tuberculosis, mostly abdominal. It is one of the forms of TB which can be easily missed due to lack of specific signs or symptoms. Do a Mantoux test. Get a family screening done. USG abdomen with or without CT abdomen is invaluable.

3.ALL can present with chronic fever, splenomegaly and normal tlc and dlc. A bone marrow biopsy is essential and peripheral smear examination to look specifically for blasts and leukaemic cells.

4.Tropical splenomegaly due to malaria could be a cause. It can present with chronic fevr and splenomegaly. But usually it also has anemia and pancytopenia due to hypersplenism.

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