Judging clinically: A case of prolong fever, jaundice, hepatospenomegaly and ascites

Age of the child is about 2 years. I came across the patient on 9th day as the patient is a relative of one of our doctor. He is suffering from fever which is intermittent in nature, occasionally rising to 103 degree F. The patient has mild jaundice. His abdomen is distended, has mild ascites, liver is moderately enlarged and tender. The patient is anorexic and irritable.

His peripheral blood picture was normal, Mp- negative, TO titre of widal test was 1:320, Urine R/E normal, US reveals mild Asites, hepatosplenomegaly. His Hb-12.3 gm/dl, Serum bilirubin -4.5 mg/dl, ALT -936 U/L, AST 312U/L, Alk phosphatase 1028 U/L. IgG and IgM for Dengue were negative, Serum Albumin 3.3 .Prothombin time 22 secs against control of 14 seconds, His HBsAg was negative. IgG and IgM against Dengue were negative.

Because of prolong fever, endemicity of enteric fever and suggestive titre, my senior colleague who is an MRCP in Paediatrics from UK was suspecting the case as an Enteric fever and giving him Ceftriaxone.

He also covered malaria by giving Quinine as the fever is high and as malaria is also prevalent in this area though his Blood for MP and ICT for plasmodium was negative. In Bangladesh one cannot rely hundred percent on the laboratory finding.

He also excluded the possibility of dengue by doing the serological test for dengue as Dengue may present with fever, ascites and jaundice.

We level the case as Acute Viral hepatitis. In Enteric fever, the lever may be involved but more in the second week and it will take time for the liver to be grossly enlarged by 9 days. It is not malaria as jaundice in malaria is rare and occurs only in sever cases and hemolytic and prehepatic in nature. Hepatic enzymes will not be increased in malaria. Liver may be enlarged in malaria due proliferation of reticulo-endothelial cells with malarial parasites entrapped inside and the spleen will be more enlarged. Present Epidimiological reports goes against Dengue at present.

We stopped quinine and other hepatotoxic drugs and patiet was given lactoluse, Inj Konakion, avoid paracetmol and sedatives. Now the patient is gradually recovering.

Badrud Doza