A
5-year-old
HIV-infected
boy
with
rash
and
abdominal
pain
(page
1/3)
|
Prepared
by...
Virat
Sirisanthana,
M.D.
*
|
|
*
Department
of
Pediatrics,
Chiang
Mai
University
|
| Patient:
A
5-year-old
HIV-infected
boy |
Address:
Chiang
Mai |
|
|
CC:
vesicular
skin
lesions,
abdominal
and
chest
pain
for
a
few
days.
|
| Present
Illness:
|
|
He
is
a
known
case
of
HIV-infected
boy.
He
has
had
several
episodes
of
"acute
febrile
illness"
and
"diarrhea"
since
he
was
3
years
old.
His
weight
and
height
were
at
the
10th
percentile
and
his
CD4
T-lymphocyte
count
was
4%
while
he
was
started
on
antiretroviral
therapy
(GPOvir30)
(ART)
a
month
ago.
He
was
not
given
primary
PCP
prophylaxis
for
fear
of
added
adverse
event
in
combination
with
antiretroviral
therapy.
10
days
PTA
he
was
exposed
to
a
person
with
chickenpox.
4
days
PTA
he
started
having
low
grade
fever.
2
days
PTA
his
mother
noticed
a
few
papular
rashes
at
his
face
and
trunk.
He
complained
of
abdominal
pain,
but
he
had
no
nausea
or
vomiting.
|
| Famillyl
History:
|
|
|
His
father
died
with
pulmonary
disease
2
years
ago.
His
mother
was
diagnosed
as
mild
symptomatic
HIV-infected
woman
a
few
months
ago.
His
elder
brother
was
healthy. |
Physical
examination:
| |
GA:
BW
16
kg
(10
percentile),
HT
104.5
cm
(10
percentile)
Vital
signs:
BT
37.5
C
(highest
temp
in
the
first
24
hours
of
admission),
PR
100/min,
RR
56/min,
BP
100/60
mmHg.
HEENT:
WNL.
Lymph
nodes:
No
significant
cervical,
axillary,
or
inguinal
lymphnode
enlargement.
Heart:
normal
S1,S2,
no
murmur.
Lungs:
fine
crepitation
both
lungs.
Abdomen:
generalized
tenderness,
no
rebound
tenderness,
liver
2
cm
below
RCM,
spleen
2
cm
below
LCM
Extremities:
no
edema
Skin:
generalized
multiple
macules,
papules
and
vesicles
over
body,
face
scalp
and
extremities.
Neuroexam:
no
neurological
deficit |
|
Initial
Laboratoy
investigations:
|
| |
CBC:
Hb
10.2
g/dL,
Hct
31
%,
WBC
2,200/mm3
(N58%,
L27%,
M13%,
B1%,
E1%)
Platelet
113,000/mm3
|
| |
UA:
WNL |
| |
Abdominal
X-ray:
WNL |
| |
CXR:
as
in
figure
1
:
|
|
|
|
|
Figure
1
Chest
X-ray
|
Problem
list:
| 1. |
HIV-infected
boy
who
has
been
on
antiretroviral
therapy
(GPOvir-30)
for
one
month.
His
CD4
T-cell
prior
to
starting
antiretroviral
therapy
was
4%. |
| 2. |
Chickenpox |
| 3. |
Pneumonia |
| 4. |
His
total
lymphocyte
count
=
2200x27%
=
<1,500
:
lymphopenia |
What
is
the
differential
diagnosis
for
his
pulmonary
problem?
Next |
BACK
to
Interesting
Case
List
|
|
