15 yr boy with bleeding gums
15 year old boy came to the OPD with the chief complaints of
Bleeding gums since 3 days
Oral ulcers since 3 days
Blackish discoloration on RT side of abdomen since 4 days
HOPl:
Pt was apparently asymptomatic 4 days back,when the mother noticed blackish blue discoloration on the right iliac area ,with no alleged history of trauma , no tenderness
Followed by bleeding gums and oral ulcerations with low grade of fever since 3 days
No H/O cough,cold,pain abdomen,loose stools, vomitings.
- H/O blackish hyperpigmented spots on abdomen and dorsum of forearm.
- no similar complaints in the past
-No H/O delayed milestones.
- pt is active in school
On examination:
Pt is conscious, coherent and cooperative
Pallor - present
Moderate dehydration
Vitals:
Afebrile
PR: 80
BP: 80/50mmhg
Spo2: 96%
CVS: s1,S2 heard
RS: BAE +, NVBS.
P/A: soft ,non tender
BS+
CNS: Normal
Blackish blue discoloration over right iliac region, inner aspect of thigh
Investigations:
Chest xray
Hb:8.7
TLC:2,500
PLT:11,000
PCV-: 25.7
MCHC: 33.9
MCV: 75.1
RBC count: 3.42
LFT:
TB: 1.29
DB: 0.31
AST: 21
ALT: 18
ALP: 198
TP: 6.3
Alb: 3.7
A/G: 1.45
NS1 antigen - negative
diagnosis:
Fever with pancytopenia ( ? Aleukemic leukemia) with cervical lymphedenopathy with splenomegaly
INVESTIGATIONS
ON 21/9/21
Hemogram
Hb- 7.4
Tlc-2,100
Rbc- 2.73
Plt-30,000
Serum iron- 69
Pt- 16 sec
Inr-1.11
Aptt-33 sec
Serum LDH- 294
recticulocyte count-0.3%
Stool for occult blood is negative
Hemogram on 22/9/21
Hb- 6.7
Tlc - 1600
Plt- 9,800
Rbc - 2.65
Pcv- 20.5
Treatment given :
Day 1
1) intravenous fluids( RL, NS, DNS)
2) INJ PANTOP 20 mg IV/ OD 8 am
3) INJ CEFTRIAXONE 1 gm IV/ BD
4) Tab DOLO 500 mg 1/2 tab (sos)
5) ZYTEE GEL FOR L/A
6) Tab DOXY 100mg PO/ OD
Day 2
1) intravenous fluids( RL, NS, DNS)
2) INJ PANTOP 20 mg IV/ OD 8 am
3) INJ CEFTRIAXONE 1 gm IV/ BD
4) Tab DOLO 500 mg 1/2 tab (sos)
5) ZYTEE GEL FOR L/A
6) Tab DOXY 100mg PO/ BD
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