Case Presentation

Medical Unit

By Dr Imran Khan
Case History
A 17 year old girl presented to the emergency room
with complaints of

• High grade fever 3 days

• Diarrhea 3 days

• Pain abdomen 4 days

• Vomiting 1 day
On Examination
• Pallor

• Dehydrated

• Febrile 102 F

• Pulse 96/min Regular

• BP 110/70mmHg

• Otherwise unremarkable
Systemic Examination
Investigations
• ECG With in normal limits

• CXR Clear

• Serum Electrolytes
Sodium 138mmol/L
Potassium 3.5mmol/L
Chloride 109mmol/L
• Random blood sugar 96mg/dl
• Renal function tests

Blood urea 10mg/dl

Serum creatinine 0.4mg/dl

• Liver function tests

Serum bilirubin 1.4mg/dl

ALT 23u/l

Alkaline phosphatase 58u/l

Ultrasound Abdomen

• Spleen 16cm ----Enlarged

• Liver 17cm with normal parenchymal echogenicity

• All other viscera were found morphologically normal

Complete blood count

• Hb 7.6g/dl

• TLC 700/ul

• Hct 22.2%

• MCV 99.6fl

• MCHC 34.2g/dl

• Platelets 118000/ul
Peripheral Smear

• Hb 7.0g/dl

• TLC 1100/ul

• MCV 109fl

• Platelets 77000/ul

• Macrocytosis

• Pancytopenia