A 4 year old Cambodian boy presented at a Hospital in Cambodia with vomiting and unable to eat. Previously he had 3 episode of falling off the chair, the bike and smash his tummy with the table while running. At the hospital he had CT brain done (result-brain swelling), lumbar puncture done (result unobtainable). He was treated as tuberculous meningitis with Ethambutol and Rifampicin and some antihypertensive drug including Captopril. two weeks after that he had convulsion while doctors attempting aspiration of the blood from his temporal area (temporal vein aspiration??). A few days after that he had upper GI bleeding and was tranferred to Thailand where we saw him. At our hospital he was diagnosed as having 1. Acute pancreatitis (with ascites, markedly increase amylase and lypase) 2. Complete Blindness (optic neuritis?) 3. Nutritional defficiency, particularly hypokalemia and hypocalcemia. The CT abdomen was done and revealed two loculation around kidney from which the fluid was aspirated under US guide. The sample was old blood. The ascites fluid was dark brown. The CSF was clear without cell. All the samples (ascites fluid, CSF, retroperitoneal pocket aspiration) were negative for gm stain, AFB stain, culture and sensitivity test. He had intermittent low grade fever and occasionally high blood pressure (upto 190 systolic sometimes)
At this stage he has good conscious and response well to verbal command but completely blind (no light perception) My concern is the blindness. Tumor or other space taking lesion is unlikely because his conscious level is too good. The drug (Ethambutol) is unlikely because it's so sudden. The other concern is whether there is any link between pancreatitis and blindness in this case.
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