Interesting Cases in Pediatrics

AN INTERESTING CASE OF AN INFANT WITH MENINGITIS!!
3 month male, presented with poor feeding, irritability for 4 to 5 days, and on examination had bulging anterior fontanelle, Hb was 8.5, total leucocytes were 21000, Platelets normal,CRP was 56, creatinine - 1.4. Lumbar puncture suggestive of meningitis.
Birth history-Born at term by elective LSCS to a G2P1 mother with normal antenatal scans, cried at birth and shifted to mother on day 1 itself.
Seeing the abnormal serum creatinine urine routine was done suggestive of full of pus cells in high power field and USG KUB S/O Bilateral hydroureteronephrosis with right sided kidney having pyonephrosis. On history recall mother admitted that the baby had abnormal urinar stream
Baby was catheterised to drain the urinary system and started on broad spectrum antibiotics which was modified according to culture reports. Baby improved symptomatically and was finally referred to pediatric surgery.

Learning points: In a sick baby screen every system for the focus of infection. In this case it was the urosepsis leading to meningitis!!!

JUST A FALL ON ROAD CAN BE LIFE THREATENING!!
6 year old boy from rural area presented with pain abdomen for 24 hours with progressive abdominal distension.
History of fall on a road in the same evening following which the child came home and complained of severe pain abdomen the very same night.
AXR flat plate done in the periphery was normal.
Next day parents brought the child to Bikaner. It was a Sunday and he was denied admission everywhere. One surgeon got a CECT Abdomen done and then referred the patient.
Usg abdomen suggestive of moderate ascites
He presented to us in the evening with shock and features of peritonitis.
He was a good weight child (wt 22kg.. adequate for 6 yrs) with no history of previous hospitalization or any prior illness.Was completely asymptomatic until 1 day back!
His serum amylase was normal.
RFTs were progressively worsening, counts were rising.

We admitted him and managed his vitals and asked for CT report which was not available till next morning.!! It was reported as Omental thickening with few subcentimetric Lymph nodes and suggested to rule out Tuberculosis!!
In view of worsening we decided to put an abdomen drain and it was bilious! So the surgeon immediately took him OT.
It was a jejunal perforation.
Repaired successfully.
Within 2 days the child recovered and we discharged him after 10 days on full feeds.

On this page I shall be sharing some interesting cases of Pediatrics which I have seen in my clinical practice all these years.
Aim of this page is to make you aware of the varied clinical presentations of these cases, how to approach and make a diagnosis.

Interesting Cases in Pediatrics Family Medicine Practice

17 year old female, presented with severe anemia with anemic heart failure.
Admitted twice inthe past with history of Packed rbc transfusions twice in the past.
First transfusion at the age of 7 years and second just 2 months back.
History of bluish spots and muscle hematomas in her childhood and excessive menstrual blood loss 2 months back(at menarche).
No history of any other significant illness.
Wt and Ht -age appropriate.

O/E severe pallor
Skin- few ecchymotic patches
Tachycardia with hemic murmur
Tachyneic with saturation at room air 93%, chest - bilateral crepts
Per abdomen soft , no organomegaly
Rest systems- NAD

Investigations
Hb 3.3g per dl
TLC 12000 (N78, L20)
Platelets 4 lacs

Pbf-s/o hypochromic microcytic anemia
Retic 6%
LFT , RFT NORMAL

BT, CT NORMAL
PT, aPTT , TT ALL PROLONGED ***
Chest x rays suggestive of pneumonitis.

Any guesses??