A thalassemic patient with prolonged fever (Page 1/3)

Prepared by……Wipada Pariyaprasert, M.D.
Thanyawee Puthanakit, M.D.
Chiang Mai University , Thailand
 
Patient : A 10-year-old girl
CC: High-graded fever for 14 days
PI:
14 days PTA; She had high-graded fever with non productive cough, no sore throat, no diarrhea and abdominal pain. She has been taken oral antibiotics for 5 days.
3 days PTA; She was brought to the hospital because she still had fever with no other specific symptoms.
The physical examination was within normal limit except for hepatomegaly. Complete blood count
and urinalysis were performed. CBC revealed Hct 18% WBC 6,600 cell/mm3 N 48% L 49%
Plt 107,000/mm3, UA was normal. She was discharged home and scheduled for follow-up
in the next 2 days.
On the day of admission; She still had high-grade fever and loss of appetite. The repeated CBC revealed Hct 15 %,
WBC 6,100 cell/mm3 N 31% L 64% and Plt 26,000 /mm3.
 
Past medical history:
  Underlying B thalassemia major, blood transfusion ~ 1 time/month.
No history of splenectomy.
Complete immunization.
 
Physical examination:
GA
A Thai girl, thalassemic face, pale, good consciousness
V/S BT 40 C BP 114/50 mmHg PR 126 / min RR 24 /min
HEENT
marked pale conjunctivae, no icteric sclerae, no injected pharynx and tonsils, no conjunctivitis,
normal ear canals and tympanic membranes.
LN no lymphadenopathy
Heart and Lung
normal
Abdomen liver 5 cm below RCM, spleen 1 cm below LCM, no tenderness
Skin
no rash, no eschar lesion
   
What is your diagnosis ?

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