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Case of the Month - April 2017

Dr SE Kubheka, M Archary and R Bobat, Department of Paediatrics Infectious Diseases, King Edward Hospital, University of KwaZulu-Natal

A 12-month-old boy was seen at a urban district hospital in KwaZulu-Natal with a 2-day history of fever, diarrhoea, irritability and abdominal distension. The stools were not blood-stained.

Three days prior to this admission his carer observed a single episode of a generalized tonic-clonic seizure associated with a fever. The infant was taken to the traditional healer where scarification of the body was performed. According to the family the infant improved over the next 2 days.

The rest of the history was unremarkable and age-appropriate vaccinations where up to date. Water source is piped water from a home tap.

On examination, his temperature was 38.5°C, pulse rate 140 beats per minute. He was well perfused but pale and irritable, no jaundice was noted.

The only clinical abnormality of note was abdominal distention with a 5cm hepatomegaly without splenomegaly. Notably the neurological assessment was normal.

Initial investigations:
White cell count32.5 x 109/l
Total bilirubin10 mg/dl
Alanine transaminase 25 IU /L
Chest radiographRight hemi-diaphragm dome shaped and elevated
HIV testNegative
CT BrainNo abnormalities noted

Question 1: What do you suspect and what would the next investigation be?

Continue to Answer 1