A 10-year-old girl presents to the emergency with high grade fever of 2-weeks duration and rashes over lower limbs for the last 7 days. Examination reveals mild pallor, generalized petechiae and hepatosplenomegaly. Investigations reveal: Hemoglobin 9 g/dL, total leucocyte count 2100/mm3, platelet count 20,000/mm3, peripheral smear shows pancytopenia, SGOT 50 IU/dL, SGPT 64 IU/dL, serum ferritin 1200 microgram/L, serum fibrinogen 100 mg/dL and serum triglycerides of 350 mg/dL. The most likely diagnosis is:
Hemophagocytic lymphohistiocytosis
Prolonged fever, hepatosplenomegaly, pancytopenia, hyperferritinemia, hypofibrinogenemia and hypertriglyceridemia fulfil the HLH-2004 diagnostic criteria for Hemophagocytic lymphohistiocytosis (HLH). Aplastic anemia does not cause hepatosplenomegaly or hyperferritinemia to this degree, and ITP would not explain the pancytopenia and organomegaly.
Important Questions from Paediatric Emergencies
- In case of hypertensive emergency in a child, blood pressure should be reduced by up to :
- At what cut-off respiratory rate will you consider "fast breathing" in a 2-year-old child?
- A child presents with headache and vomiting in the emergency room following a fall from the bed. Which one of the following treatment modalities is not recommended in the emergency room?
- The recommended ratio for chest compression to breaths administered by a single rescuer during resuscitation of a child in cardiac arrest is:
- A 4-year-old comatose child is assessed by the Modified Glasgow Coma Scale. Which of the following is the correct interpretation of the score given as E2V3M2 for the best eye opening response, best verbal response and best motor response respectively?
