Dr. Ankur chauhanover 7 years ago

Age 5yrs old male Informant Parents PC Fever x 3/52 Vomitting x 3/52 Passage of loose stools x 3/52 Skin rashes x 2/52 Inability to open the eyes x 5/7 HPC Child was in apparent good health until about 3/52 prior to presentation, when he was noticed to be having fever, which was low grade intermittent, then became high grade, continous, which was temporarily relieved with ingestion of syrup PCM. There was also associated vomitting which was non projectile, containing recently ingested feeds, estimated volume of about 50-100mls each bout. Had about one episode daily for the 1st 3days of the illness, before resolving. Passage of loose stools started at about the same time, which was watery, had about one episode daily also for the 1st 3days before abating. was also said to be weak and drinking water eagerly afterwards There was also a history of skin rash, which started 2/52 prior to presentation, started on the neck, which was small in size, about size of a peanut, then gradually increases in size to about that of a smallberry, said to contain clear fluids, before bursting, revealing a pinkish skin. It then progressed from the neck to the head, before involving all the parts of the body. The rash Involved the genital area, as urination became very painful, at the peak of the rash. Also involved the eyelids which later started having milky discharge from the eyes, shortly before the patient was unable to open the eyes. Since onset of illness, patient has been taken to a local pharmacy store where drugs were given , names of which could not be remembered(2 injections, and one oral suspension drug for 2days) With further worsening of the childs condition, parents resorted to local traditional medications, which was given 3times daily, made up of wet leaves, all to no avail, shortly before the occurence of the rash Pregnancy was not booked for ANC, but mother said it was carried for 9months, Delivery was at home, assisted by a traditional birth attendant. Was said to have cried immediately after birth. Cord was cut using a new razor blade, and had cord formentation with hot charcoal, although no history of fever, yellowish discoloration of the eyes or convulsions in the neonatal period. Was put to breast at about 2days after birth, and was exclusively breastfed for about 7/12 before introduction of unfortified PAP. Started family diet at 10months of life, and is currently on it 24 hr dietary recal includes Unfortified PAP for breakfast, the same PAP for lunch and dinner 24hrs prior to presentation, although in the premorbid state, the 24hrs dietary recal includes, PAP for breakfast, tuwo for lunch and tuwo for dinner History of immunization is sketchy as the mother could not accertain wat time and times of immunization, but she confirmed that he has had some immunizations, at home administered by health care workers who visited their community. Developmental milestones could not be fully accertained by the mother, although said the patient sat without support at 7/12, and walked at 14months of age. Child is the 7th child born born to the mother in a polygamous setting, father has another wife who has 2children. Patient with mother and 6 other siblings sleep in one room thatched apartment, poorly ventilated Source of drinking water is stream water. Cooking fuel is with firewood, Refuse disposal is via open dumping O/E Acute on chronic ill looking child with bony prominences zygomatic arch, ribs and pelvic bones Febrile temp 39.1*C, pale, not cyanosed, mildly dehydrated, not jaundiced Has peripheral lymph node enlargement(Cervical submandibular, axillary, and inguinal , about 1x2cm, non tender), No pedal edema, Has generalised macular hypopigmented patches all over the body, average size is 2x3cm, non tender Buccal mucosa erythema and bleeding, with hyperemic gingiva, with areas of necrosis. Has healed skin patches on the head, and lower limbs Wt 10.5kg(75% EWA) MUAC 11cm(low) Lenght 102cm OFC 52cm CVS HR 120b/min HS 1 and 2 RESP Not in distress RR 34r/min Bronchovesicular BS SPO2 93% Off O2 ABD flat soft MWR Liver is 4cm enlarged, non tender, firm smooth surface SoKo BS Present and normal CNS Conscious, Irritable in pains No signs of meningeal irritation Tone reduced in the limbs Reflexes intact