Lymphadenopathy in pediatric oncall

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Lymphadenopathy

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Rakesh Kumar, Puja Bhagat Department of Pediatrics, Katihar Medical College, Katihar, Bihar, India ...

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	Specialist Answers
Question Category : Lymphadenopathy
My son 4 years,incidentally detected by me to have lymphadenopathy at posterior triangle,inguinal region. they are discrete, non tender,size < 1cm each.he has seborrhoea at present.recent uRTI 3 times within 1 months. other wise he is alright except under weight since child hood with normal height and intelligence. what should be my next approach? Check Out the Answer
Question Category : Lymphadenopathy
A child, who is 4 year/ 4 month old , > dob: july-2004. Child had neonatal pustulosis- treated with antibiotics.< child had inguinal hernia and emergency surgery was performed at 7 months of age. 1 yr of age child had bcg adenitis, mt+ve, ln biopsy revealed langhans giant cell child was given first course of akt for 6 months, child was apparently ok for the next 7 months. 2 yrs 4 months child had loose motions, fever, not gainig weight, thriving well childs barium meal follow through was done which revealed ileal narrowing was diagnosed to have abdominal tuberculosis and was again started on akt for 9 months, child started gaining weght and was thriving well for apparently next 6-7 months. 2yr 9 months child had radiologically proven pneumonia with hilar lymphadenopathy and he was given a course of anti biotics for the same ,chest lesion resolved. 3 yr 2 months- high grade fever, persistent child was treated for enteric and malaria. Aprill 2004 , child came with persistent fever, xray chest revealed widened mediastinum,ct chest revealed mediastinal ln, parenchymal lung lesion over left lung base, extending upto pleura, with pleural effusion.multiple small paraaortic ln + mt -ve, child was given a course of akt ( third time 2 sehrz+1ehrz+ 6 hr) which child was still taking till last episode. Gained wt around 1 kg. Bal was done - no afb, pcr -ve. July-2004 child presented with persistent irritation or urethra, no hematuria but frequency + usg - kub revealed a thickened post wall of bladder, cystoscopic biopsy was done which did not show any granuloma, but did reveal chronic inflammation with multi layering, polypoidal lesion. Afb-ve, pcr- ve, child was continued on akt. Child again had persistent fever 2 months later, which subsided with anti pyretics. Child again came to us on 2nd nov, with high grade fever, cough, occ. Loosemotions, heaptsplenomegaly+ no visible lnodes. Ct chest/abdomen revealed the size of ln had gone down significantly, fresh lesion on the rt. Lung base, no abdominal lnodes. This childs all his routine investigations were normal all the time except esr which was 30 to 50 during all episodes. And hb was around 9-10, culture never grew any organism. This time considering a probability of drug fever all medicines were stopped, but fever still persisted. My impression was a chronic intercurrent infection / inflammation involving reticuloendothelial system without evidence of hypersplenism, with involvement of lung parenchyma and gitract.d/d comes to tb. Primary immune deficiency to be ruled out. Hiv -ve. What is ur opinion Check Out the Answer

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