A 16 yrs girl with prolonged fever(PUO)-bsmmu.pptx

approaching to pyrexia of unknown origin

1. A 16-Year- Old Girl with Prolonged Fever Presented by Dr. Rana Shaha D-Card Student Violet unit (Internal Medicine) BSMMU

2. Follow up presentation: Name:Kasfia Binte Mahbub Age: 16 years Initial Presentation: Fever- 2 months Lymphnode - Single Post. Cervical FNAC done and report: Kikuchi’s disease

3. Prednisolone started LN regressed But fever persisted Admission BSMMU on 30.01.2024 Persistent fever No Lymphadenopathy, organomegaly, Systemic features Empirical Anti TB- 8 days

4. Investigations: CBC- Hb-12, ESR-Normal, Total count-Normal PBF- Microcytic hypochromic CRP- 8.1, Blood and Urine Culture-No growth CXR- Normal USG Of WA- Normal CT chest- Normal CT abdomen- Right adnexal septated cyst (3.7* 3.2cm) CA 125- Normal

5. ANA, Anti Ds DNA, RA, Anti CCP, cANCA , pANCA - Negative Thyroid USG- Small cystic nodule in rt lobe FT4: 1.10 ng/dl, S.TSH: 6.19 µIU/mL Anti HIV, ICT Malaria, kala-azar- Negative MT- 02 mm Echo- Normal BM- Normal active marrow, BM Gene xpert - Not found

6. Presented on grand round session and decision was made to wait and watch Patient was discharged with proper counselling and tapering dose of steroid 2 months Now Patient again admitted with Fever without any localizing sign

7. New Temp. Chart

8. Recent Investigations: CBC: Hb:12 g/dl ESR:10 mm in first hour Total WBC count:13000/ cumm Total platelet count:370000/ cumm MCV:76.2fl MCH:23pg MCHC:30.2g/l Blood film :Microcytic hypochromic anemia neutrophilic leucocytosis Usg of whole abdomen : No significant abnormality is detected Chest x ray P/A view : Normal Blood and Urine C/S: No growth

9. ANA :Not detected Anti-ds-DNA:Negative CRP:6.2mg/L Procalcitonin :0.04(negative) LDH:183U/L ALT:24U/L S.creatinine:0.84mg/dl S.electrolytes : Sodium -142mmol/l potassium-3.8mmol/l Chloride-103mmol/l T-CO2:25.2mmol/l

10. Problem list What is the diagnosis? What investigations we will do next?