A
6-year-old
HIV-infected
girl
with
neck
mass
(page
1/3)
|
Prepared
by....
Thanyawee
Puthanakit,
M.D
Virat
Sirisanthana,
M.D.
|
| Patient:
A
6-year-old
girl,
Address:
Lamphun
province |
| CC
:
Left
cervical
mass
for
4
weeks |
Present
Illness:
| 1
year
PTA
: |
She
presented
with
thrombocytopenic
purpura
and
wasting.
Further
investigations
revealed
that
she
was
an
HIV-infected
child
(CDC
clinical
category
C).
Prednisolone
was
prescribed
for
the
thrombocytopenia
which
gradually
subsided.
Since
then,
she
was
put
on
co-trimoxazole
for
primary
PCP
prophylaxis. |
| 6
wk
PTA:
|
Because
of
her
immunological
suppression
(CD4
cell
percentage
was
4%
and
CD4
cell
count
was
97
cells/
mm3)
and
the
high
viral
load
(359,000
copies/ml
or
5.56
log10),
she
was
started
on
highly
active
antiretroviral
therapy
(GPOvirS-30,
which
is
a
combination
of
stavudine
30
mg
+
lamivudine
150
mg
+
nevirapine
200
mg).
She
was
on
half
a
tablet,
orally
every
12
hours.
|
| 4
wk
PTA:
|
After
2
weeks
of
GPOvirS-30
,
she
developed
left
cervical
node
lymphadenopathy
2x3
cms
in
diameter,
firm
consistency,
mild
tender
(figure
1)
with
low
grade
fever.
She
was
treated
as
bacterial
infection
with
cloxacillin
syrup
for
2
weeks
with
no
response.
The
mass
gradually
enlarged
in
size
to
4x6
cm.
in
diameter
(as
in
figure
2),
and
she
developed
daily
moderate
grade
intermittent
fever. |
|
|
|
|
Physical
examination:
| |
GA:
A
girl,
febrile,
mild
pale
V/S:
BT
(highest
peak)
39.5
C
(see
temperature
chart
in
figure
3),
PR
130/min,
BP
100/70
mmHg,
RR
36/min,
BW:
10.5
kg
(<
3rd
percentile)
Ht:
88
cm
(<
3rd
percentile).
Her
weight
curve
has
been
passing
2
major
percentile
lines.
HEENT:
mild
pale
conjuntivae,
no
icteric
sclera,
TMs:
normal,
no
dental
caries
Lt.
supraclavicular
node
enlargement
4X
6
cms,
firm,
irregular
surface,
fix
to
underlying
soft
tissue
and
tender
(fig
2)
Heart:
regular
rhythm,
normal
S1
S2,
no
murmur
Lungs:
normal
breath
sound,
no
adventitious
sound
Abdomen:
soft
liver
4
cm
below
RCM,
spleen
3
cm
below
LCM
Ext:
no
skin
lesions
|
|
|
|
|
Figure
3
Body
temperature
|
|
What
is
your
differential
diagnosis?
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