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Case of the Month - April 2015

Buhle Makongwana, Helena Rabie and Mark Cotton

An 8-month old infant presented with 3-day history of:

  • Increasing cough,
  • Poor feeding,
  • Struggling to feed with effort and
  • Loose stools

10 days prior he had a cold

He was not HIV exposed but had a history of a tuberculosis contact.

On clinical assessment:

  • Generally well grown, apyrexial, pulse rate 175-180 beats per minutes, respiratory rate more than 60 breaths per minute saturation in air was 87% but improved on nasal prong oxygen
  • There was no rash, conjunctivitis or mucosal redness, and lips where not cracked or red
  • He was poorly perfused with a thready pulse
  • The praecordium was active and there was a gallop rhythm but no murmur
  • There was a 5 cm tender hepatomegaly without splenomegaly
  • Extremities and joints where normal.

Figure 1: The ECG showed a sinus tachycardia and ST elevations

Figure 2: The CXR showed: pulmonary infiltrates with a slightly increased cardiothoracic ratio

The transthoracic ECHO-cardiogram confirmed severe left ventricular dysfunction dilation with an ejection fraction of less than 20 with moderate mitral and tricuspid regurgitation.

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