A girl with high grade fever and hepato-splenomegaly (Page 1/3)

Prepared by...
Uthen Pandee, MD.
Vorasith Siripornpanich, MD.
Peninnah Oberdorfer, MD. PhD.
Department of Pediatrics, Chiang Mai University, Thailand

A Thai 13-year-old girl. Address:Chiangdao, Chiang Mai, Thailand

Chief compliant: Fever for 5 days prior to admission
Present illness:
> 5 days prior to admission she has had high grade fever with chills. She also developed headache, generalized abdominal pain, and nausea. She has no diarrhea but she has poor appetite. She went to a private clinic with her parents and the doctor gave her antipyretic drug but she was not improved. With the continuing high fever she has been getting weaker and weaker, so the parents brought her to the hospital.
Past history:
> She is the second child of the family with four children.
> Her village is at the border between Northern Thailand and Myanmar
> She did not have any underlying diseasse, nor history of drugs allergy nor a family history of hematologic disease.
Physical examination
GA: A girl, normal consciousness, looks malaise, Weight 35 kg
V/S: T 39 C, PR 136 /min, RR 24 /min, BP 80/40 mmHg
HEENT: mild pale conjunctiva, no icteric sclera, dry lip, no sunken eyeball, no injected pharynx
Lymph node: can’t be palpable
Heart: regular, normal S1 S2, no murmur
Lung: clear, no adventitious sound
Abdomen: flat, soft, generalized tenderness, no guarding, liver 7 cm below RCM, span 13 cm,
spleen 4 cm below LCM
Extremities: no edema, no petechiae, no rash, no eschar
Neurological examination: good consciousness, CN : intact, normal muscle tone and power, stiffness of neck : negative
Problem list:
1. High fever with chill for 5 days
2. Anemia
3. Hepatosplenomegaly
4. Hypotension

What are differential diagnoses? Next to Page 2


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