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CHIEF COMPLAINTS
A 13yr old boy came to old with chief complaints of yellowish discoloration of the eyes, yellowish green coloured vomitings and also had yellow coloured urine since 9days.
Patient history :
At birth:
Patient developed jaundice and it resolved spontaneously
At 8 months:
He had altered bowel movements ,for 1 week he had loose stools and another week he had normal consistency.later he had loose stools every day for 2-3 days during which he became cachetic.He got admitted in hospital and they mentioned as suspected case of celiac disease,chronic diarrhoea,chronic malabsorption. He was treated with IV antibiotics and 2FFP transfusions. He recovered within 3 months.
He also had recurrent attacks of cold,cough and fever.He used inhalers for 1 year during winters.
At 9years:
He had neck swelling and diagnosed with hypothyroidism (Initial TSH levels-150)He was started with THYRONORM 150mcg which later increased to 180mcg.
He also had chronic itching over hands and foot since the age of 9years.
At 12 years:
He had chickenpox and resolved within 10 days.
At 13years(Now):
He came with complaints of yellowish discoloration of eyes ,dark yellow color urine since 9days.Also had one episode of bilious vomiting.
No history of fever,chills,abdominal pain,loose stools,c old ,cough,joint pains.
FAMILY HISTORY:
He is a 4th order child ,born out of grade 4 consanguinous marriage
He has 2 elder brothers and one elder sister - who expired at 5 years of age .
His sister was the first child and she was assymoptomatic till 2 years of age ,then she had shortness of breath and was rushed to hospital,where here condition detiorated and got admitted .They were told that she had splenomegaly and Her blood counts were decreasing .She was given multiple blood transfusions every 25 days for one year inspite of that she remained anemic ,she also underwent bone marrow biopsy twice .
According to parents she was given steriods also for one year before death .she never had jaundice or recurrent infections.
.Elder brother is 19 year old and second brother is -16 years old .
Second one had history of fever ,white coloured loose stools at the age of 5 years ,for which they went to nalgonda hospital .He was given some medications and it got resolved .But he was said to have anemia ,and he recovered according to parents with some medications.There was no jaundice and no history of blood transfusion.
PERSONAL HISTORY
Diet:mixed
Appetite:normal
Sleep:normal
Bowel and bladder movements:regular
No addictions
GENERAL EXAMINATION
Patient is conscious, coherent and cooperative
Pallor-present
Icterus-present
Cyanosis,Clubbing,Lymphadenopathy, oedema-Absent
VITALS:
Temp:afebrile(98.6°F)
PR:90bpm
RR:22cpm
BP:120/70mmHg
SYSTEMIC EXAMINATION
CVS:S1,S2 Heard shift in apex beat to 4th ics
RS:BAE+
CNS:NAD
P/A: Abdomen is distended and spleen is palpable.
INVESTIGATIONS:
PROVISIONALDIAGNOSIS:SPECTRUM OF AUTOIMMUNE DISEASE-THYROIDITIS.
AIHA(AUTOIMMUNE HEMOLYTIC ANEMIA)
CVID
TREATMENT:
TAB.METHYLPREDNISOLONE 32mg PO/OD
TAB.THYRONORM 200micrograms PO/OD
Monitor vitals for every 4hrs.
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