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A wasting 3-year-old boy with high intermittent fever for 7 days

Prepared by...
Virat Sirisanthana, M.D.
Department of Pediatrics, Faculty of Medicine, Chiang Mai University
Patient: A 3-year-old boy
Address: Chiang Rai
CC: High fever for 7 days

Present Illness:

  • 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
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)
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.
  • 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
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
Diagnosis: Click here

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