a patient 13 years of age presented with history of high grade fever for 15 months and upper GI bleed for four days.
she gives on and off history of fever..
on inspection abdomen is normal, no visceromegaly, no ascites....dopplerscan was normal confirming absence of non cirrhotic portal hypertension.
she has a hypopigmented diffuse patch over the forehead spreading down the temporals and extending upto the hair line.
no lymphnodes palpable.
she has absence of secondary sex charecters. short stratured and low wieght and hieght for her age. no pubic axillary hair.
investigations: pancytopenia, RFTS n LFTS are normal...
i cannot get a diagnosis??
what should be the next step???
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