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Please help me. My 4 year old Baby girl has fever for almost 4 months

Posted In: Medical Stories 1 Replies
  • Posted By: Anonymous
  • September 23, 2007
  • 01:03 PM

Her fever start last June 1 2007. She still has fever everyday until now though not as high grade as before(40.6 - 41, 24 hours last 2 months ago) and now ussually goes away 1 - 4 hours and usully every morning. after giving paracetamol. she still has bone pain still migrating from one part to another . she still has more tests to be done like bone scan and special staining. Please see below.. this are the test that she has..



TIONGSON, CARMIE FRANCINE Quantitative/Qualitative Medical Summary
DATE NORMAL VALUES unit 13-Jun 14-Jun 20-Jun 22-Jun 26-Jun 12-Jul 13-Jul 14-Jul 16-Jul 19-Jul 21-Jul 31-Jul 3-Sep 6-Sep
WBC COUNT 5-10 x 109/l 20.7 20.9 12.6 19.68 20.06 9.76 20.12 25.4 19.88 20.4 18.6
HEMOGLOBIN 120-170 g/l 126 126 110 98.8 87.7 119.5 106.2 112.8 101.6 106 101
HEMATOCRIT .36-0.51 0.37 0.37 0.33 0.28 0.26 0.34 0.31 0.34 0.3 0.33 0.33
RBC 4.0-6.0 x 1012/L 4.15 4.22 3.74 3.72 3.45 4.64 4.12 4.31 3.9 4.1 4


DIFFERENTIAL COUNT
SEGMENTERS .40-.70 0.87 0.87 0.75 0.77 0.57 0.8 0.82 0.83 0.79 0.88 0.81
LYMPHOCYTES .20-.40 0.12 0.13 0.25 0.15 0.39 0.2 0.11 0.09 0.12 0.12 0.18
PLATELET COUNT 150-400 x 109/l 440 430 210 804 513 500 509 625 644 598
MPV 6.5-12 Fl 6.59 6.84 7.85 7.22 7.27 6.72
RETICULOCYTES .05-1.5 % 23
MCV 80-97 fl 74.27 76.1 77.36 77.21 78.8 76.69
MCH 27-31 pg 26.57 25.55 25.73 25.75 26.19 26.09




EOSINOPHILS .00-0.05 0.01 0.02 0.01 0.02 0.02 0.03
ESR 0-20 mm/hr 77 54 60
LDH 240.00-480.00 IU/L 1029 1342 762 665
ANA NEGATIVE NEGATIVE

URIC ACID 2.39-5.7 mg/dl 4.02
TYPHIDOT NEGATIVE



URINALYSIS JUNE 13, 2007 JUNE 18, 2007
COLOR LIGHT YELLOW LIGHT YELLOW
TRANSPARENCY CLEAR SLI TURBID
SPECIFIC GRAVITY 1.005 1.005
Ph 6.0 7.5
ALBUMIN NEGATIVE NEGATIVE
SUGAR NEGATIVE NEGATIVE
WBC 0-1/HPF 1-3/HPF
RBC 2-3/HPF 0-1/HPF
BACTERIA RARE FEW
EPITHEDIAL CELLS RARE FEW
SEROLOGY
ASO NEGATIVE
CRP 10MG/L LESS THAN 8 JUNE 18

Other Tests Performed
1 STREPTOCOCCUS ANGLNOSUS = MODERATE GROWTH 18-Jun
2 BLOOD C/S WITH ARD PEDIA = NO GROWTH AFTER 48 HRS OF INCUBATION 17-Jun
3 BLOOD C/S WITH ARD PEDIA = NO GROWTH AFTER 7 DAYS OF INCUBATION 22-Jun
4 TYPHOID = NEGATIVE 13-Jun
5 CHEST X- RAY / APL = NEGATIVE 13-Jun
6 LE PREP= NEGATIVE 25-Jun
7 MALARIAL SMEAR = NEGATIVE 24-Jun
8 BMA W/ CULTURE = NEGATIVE/No Growth 15-Jun
9 BMA W/ CULTURE = NEGATIVE / No growth 16-Jul
10 BENCE JONES PROTIEN= NEGATICE 27-Jul
11
12
13
MALARIAL SMEAR
THICK & THIN SMEAR = NEGATIVE
QUANTITATIVE BUFFY COAT = NEGATIVE

Multiaxial chest and abdomenal CT w/ contrast July 09, 2007
Impresion:
1.Inferior Midline Mesenteric Mass and/or enlarged node
2.Normal Chest CT scan
3. Normal Liver, biliary tree pancreas and spleen
4.Normal kidneys, Ureters and urinary bladder
5. Infantile pelvic organs

Post Exploratory Laparotomy - Surgical Pathology report July 17, 2007
Specimen: Ileal mesenteric lymph node
Final Pathological Diagnosis: Reactive Lymphadenitis, Lymph node, (Mesenteric)
Microscopic Description:
Microscopic examination reveals a benign lymphoid tissue with a thin fibrous capsule .
It has several vary sized folicles with mixed population of cells.
Some areas shows dilated sinuses filled with mature hystiocytes. No Malignant cells seen.

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  • God bless you!! When a child is sick, we feel so helpless. Please read the attached info. Maybe it will be of some help. Best of luck, and I will keep you in my thoughts and prayers!!R Pediatric Otolaryngology Study Guide: Pediatric Neck Mass Depatment of Otolaryngology - UT Memphis. Some material deleted due to not enough of space. Key Points: 1. Lymphadenopathy has been reported in up to 100% of children. 2. On initial presentation, children with suspicious lymphadenopathy should undergo screening, laboratory tests and a complete history and physical examination. 3. Biopsy is indicated for lymph nodes which are large (2-3 cm), in an unusual location or do not regress with conjunctive therapy. 4. An antibiotic trial, consisting of an anti-staphylococcal drug should be given. If an inadequate response takes place, the node should be biopsied. A repeat trial should not be given. 5. Both open excisional biopsy and fine needle biopsy have a place in the management of lymphadenopathy. 6. Congenital cysts in children are common. When enlarging or infected, they should be excised. Ideally, this is done when the child is three to four years of age. ____________________Masses in the neck of children are caused by a wide variety of etiologies. Table 1. They may historically be characterized by the presence or absence of pain, their rate of growth, and their location.1 Physical examination confirms their location and provides information on how solid they are, how distinct their edges are, and whether or not they are fixed to the skin or underlying tissues. The status of overlying skin or mucosa is also of importance. Differentiation of a clinically suspicious versus a non-suspicious neck mass is very important. Thirty-eight percent of children from zero to six months of age have palpable lymphadenopathy in the head and neck region beginning as early as six weeks of age.3 In general, the younger child usually has occipital and postauricular adenopathy as the older child usually has cervical lymphadenopathy. Lymph nodes which are greater than 3cm should always be viewed with a great deal of suspicion. Likewise, posterior and lower cervical nodes are more apt to harbor a malignancy. Lymph nodes are not normally found in the supraclavicular region. Nodes in this area have been reported to have up to a 60% malignancy rate.29 Tender neck masses in the jugulodigastric area (beneath the superior portion of the sternocleidomastoid muscle) presenting in a febrile child, are often infectious in etiology. In those cases, lymphadenitis and infected congenital cysts are at the top of the differential diagnosis. The latter must be seriously considered if an etiology for the infected nodes are not found. Non-tender small lymph nodes (less than 1 cm) in this area are common in children and may represent a slowly resolving lymphadenitis or a reactive lymphadenitis from a low grade chronic tonsillitis. Initial screening tests including a chest x-ray, complete blood count with differential, monospot, taxoplasmosis, and cytomegalovirus, and cat scratch fever titers should be considered. A physician must interpret these tests carefully because infections from Toxoplasma gondii, Epstein-Barr virus, and cytomegalovirus occur in a large percentage of the population. These infections can be indolent, sub-clinical and last for a protracted period of time. Thus, one must be very careful to form a diagnosis based on a positive laboratory test, because it may be an associated rather than an etiological finding. The child should also be placed on an anti-staphylococcal antibiotic for at least two weeks and re-evaluated in four weeks. If the node has not reduced in diameter by 50%, biopsy is indicated. The choice between needle aspiration and open biopsy will depend upon the clinical situation and the available pathological facilities. It should be noted that there is a small but definite false negative rate with needle aspiration. Adult needle aspirations are often done to differentiate squamous cell carcinoma from lymphadenitis, as in children, the differential of lymphoma from lymphadenitis is often more important. If an open biopsy is performed, the tissue should be sent for culture (fungal, viral, acid fast, and bacterial), touch preparations (to evaluate for lymphomas) should be done and special stains (acid fast and fungal) ordered. If the tissue is immediately put in formalin and sent to pathology, cultures and touch preparations will not be obtainable. Lymphadenitis: Enlargement of lymph nodes in children are most often in response to infection either acute or chronic and maybe a local or systemic phenomenon. Lymph nodes in the neck drain into fairly predictable areas of the head and face. These should diligently be searched for a source of inflammation. Table 2 describes the general pattern of drainage. Pustules, furuncles, acne, dental infection and oral lesions may all cause localized lymphadenitis. Children in particular, have a tendency to go on to suppurative lymphadenitis which may grow out staphylococcus, streptococcus, or may be sterile. These present as a tender, red, enlarging mass which eventually point like any other abscess. Usually they are treated with needle aspiration and penicillin, but occasionally they require formal incision and drainage. Chronic, painless lymphadenitis may be caused by many bacterial, fungal, viral, and parasitic infiltrations. Many of the more common etiologies are listed in Table 3. Often, no etiologic agent is identified and on biopsy the node is found to have follicular hypertrophy and is described as “reactive”. Systemic lymphadenitis may present initially in the head and neck. Mononucleosis classically presents with bilateral posterior triangle lymphadenitis along with malaise, fever, anorexia, and often, adenotonsillitis. Lymphoma may also present with a similar picture and appropriate laboratory tests should be done for any lymphadenitis or tonsillitis that does not properly respond to antibiotics. Solitary masses of non-lymph node origin: While relatively uncommon, solitary firm, enlarging masses do occur in children and are usually congenital (such as dermoids or teratomas) or neoplastic. Rhabdomyosarcoma is the most common soft tissue sarcoma, but the variety of childhood sarcomas are exhausting and beyond the reach of this discussion. Fine needle aspiration is playing an increasing role in diagnosing such neck masses. The increased survival of such patients when treated by wide surgical excision and aggressive radiation and chemotherapy mandates their early recognition. Dermoids are not uncommon in the submental area. Branchial cleft cysts result from remnants of the embryologic gill clefts that fail to resorb. They usually present in the mid-lateral neck just under the border of the sternocleidomastoid muscle. They are often part of a track which may start as a dimple of skin at the anterior neck, run across or between the internal and external carotid arteries, over cranial nerves X through X12 (and sometimes IX) and end at either the tonsillar pillar or pyriform sinus. Simple incision and drainage or incomplete excision will result in a recurrence and a difficult revision surgery. Thyroglossal duct cysts are analogous to those of branchial cleft origin, but present in the midline anterior neck, usually below the hyoid bone. They elevate with swallowing and are a discrete mass. On initial presentation, they are seldom fixed to the lobe of the thyroid, extend upwards through or around the mid-portion of the hyoid bone and end at the base of the tongue. Such a tract follows the embryologic descent of the primordial thyroid. A cyst may occasionally contain the patient’s total thyroid tissue. Preauricular Masses: Preauricular masses can be caused from disease involving the scalp, nasopharynx, parotid and orbit. Conjunctivitis caused by adenovirus or chlamydia is a common etiology.4 If they involve the parotid gland excision, it will always place the facial nerve at risk. A small dimple with or without mucoid drainage that is located just in front of the ear is most likely a congenital pit formed by abnormal auricular development. These are easily infected and if draining, require total excision. However, this should not be taken lightly. A first branchial cleft cyst may present in this manner with deep extension and possible facial nerve involvement. Also, an occasional parotid tumor may present in this fashion. Postauricular Masses: Postauricular masses may be a manifestation of either scalp, ear or systemic disease. External otitis media or mastoiditis may be associated with postauricular lymphadenopathy. Scalp disorders, especially those associated with scratching, are one of the most common causes of this disorder. Fleas, ticks and lice must be carefully searched for and if found, the entire family should be treated. Lymphomas and other systemic disease are rarely present in this area, but their existence should be ruled out if the nodes persist or increase in size.
    Anonymous 42789 Replies
    • September 24, 2007
    • 05:43 AM
    • 0
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