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Prepared
by...
Virat Sirisanthana, M.D.
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|
Department
of Pediatrics, Faculty of Medicine, Chiang
Mai University
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| Patient:
A 3-year-old boy |
| Address:
Chiang Rai |
| CC:
High fever for 7 days |
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Present
Illness:
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- 3
months PTA he started having "on
and off" fever, mild but progessive
dry cough, and losing weight.
- 1
month PTA he was admitted for 6 days at
a primary care hospital with "on
and off" fever and poor feeding.
He got better and was discharged.
- 7
days PTA he developed high intermittent
fever
- 3
days PTA he was admitted in the primary
care hospital. He remained febrile, so
his mother took him to CMU hospital
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| Past
History: |
- Birth
: BW 3.3kg,vacuum extration, had mild
jaundice (on phototherapy), stayed in
hospital 4 days.
- Feeding:
Breast milk until 7 mo. old,
- Immunization:
as schedule
- G+D:
with in normal range (3 months ago his
body weight was 11+ kg , 10%tile)
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| Physical
Examination: |
- Body
wieht 9.4 kg (< 3th %), fully concious
- VS:
Temp 40 C, RR 30/min, P 120/min
- SKIN:
there is a small papule(3 mm in diameter)
with 1 mm central dark spot at his chin.
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- HEENT:
pale conjunctivae,
- CHEST:
Lung; no adventitious sound, Heart; normal
heart sound
- ABDOMEN:
Liver 3cm. below RCM, spleen 2 cm below
LCM
- EXTREMITIES:
WNL
- No
diarrhea after admission
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| LABORATORY
INVESTIGATIONS: |
- CBC:
Hb 6mg%, Hct 19%, WBC 3,100 (N58 L42),
platelet count 55,000/cbmm
- UA:
WNL
- CXR:
Bilateral lower lobes infiltrations and
RML infiltration (figure
3)
- Nicking
the skin lesion, smeared and stained with
Wright stain: shown in Figure
4.
- Bone
marrow aspiration: shown in Figure
5, 6
- HIV-Ab:
positive
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