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