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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