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.
Question 1: What do you suspect and what would the next investigation be?
|White cell count||32.5 x 109/l|
|Total bilirubin||10 mg/dl|
|Alanine transaminase ||25 IU /L|
|Chest radiograph||Right hemi-diaphragm dome shaped and elevated|
|CT Brain||No abnormalities noted|
Continue to Answer 1