| 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 ?
|