Virat Sirisanthana, M.D.
of Pediatrics, Faculty of Medicine, Chiang
A 3-year-old boy
High fever for 7 days
months PTA he started having "on
and off" fever, mild but progessive
dry cough, and losing weight.
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.
days PTA he developed high intermittent
days PTA he was admitted in the primary
care hospital. He remained febrile, so
his mother took him to CMU hospital
: BW 3.3kg,vacuum extration, had mild
jaundice (on phototherapy), stayed in
hospital 4 days.
Breast milk until 7 mo. old,
with in normal range (3 months ago his
body weight was 11+ kg , 10%tile)
wieht 9.4 kg (< 3th %), fully concious
Temp 40 C, RR 30/min, P 120/min
there is a small papule(3 mm in diameter)
with 1 mm central dark spot at his chin.
Lung; no adventitious sound, Heart; normal
Liver 3cm. below RCM, spleen 2 cm below
diarrhea after admission
Hb 6mg%, Hct 19%, WBC 3,100 (N58 L42),
platelet count 55,000/cbmm
Bilateral lower lobes infiltrations and
RML infiltration (figure
the skin lesion, smeared and stained with
Wright stain: shown in Figure
marrow aspiration: shown in Figure