Detailed Query: I have an eight year old girl as my patient. She has history of development of boil on minor trauma or after intramuscular injections. She actually needed I&D three years back for that. She has been well untill a month ago. Then she developed fever and jaundice. And also multiple very large skin lesion on her extremities and trunk. These lesions are skin coloured, bullous but empty from within( means no fluid inside),they rupture showing ulcerative wound inside and then they heal over weeks.There is wrinkling, and depigmentation of overlying skin of lesion. Initially her labs showed lymphopenia. But on iv antibiotics it got settled. On ultrasound there is hepatospleenomegaly and both kidneys are enlarged. Her creatinine is normal. Hepatitis A IgM is negative. Serum IgA and IgE are at lower normal limit while S.IgM is high(may be due to acute infection).S. IgG is normal.She is HIV negative. ANA is also negative. Another problem with her is that she keeps on droping her Hb even after transfusion. While her retic count is normal and coombs is negative. Her hepatitis settled in 2-3 weeks. But we yet dont have any diagnosis. Kindly help me.
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its very likely that medics and paramedics hide information and donot agree with my impression. Also as they are cued by some other disease diagnosis already, my experience is that information provided to me by medicos is always biased and incomplete.
pls try to clarify... different disorders..
1. vesiculobullos disorders.. fluid isnt must every time
2. autoimmune anemia? or a bonemarrow suppression you havent specified how low the Hb drops and how often transfusion may be needed. how many CBC reports are available? was the same trend all the time? how many retic count reports were available? what was RDW?
3. skin biopsy and skin ref?
your detailed info will help me analyze the situation more better. ** Your email reply won't reach me if you are not in my address book, so do not reply to this email. If you feel like commenting answering or replying .. for further communication; please do repaste this answer and query along with as i donot store the communications all the time. however you may comment at website if it gets published at www.pediatricianonline.in ** Disclaimer: The contents of this blog/mail are for informational purposes only and should not be construed as medical advice or substitute for professional care. This is not a professional or clinical consultation. Never disregard professional medical advice or delay in seeking it because of something you have read on this site. An examination or decision by a doctor can not be completed unless he/she had personally examined the patient through professional consultation. However this site/mail will help you understand problems, discrepancies and clarify doubts and misunderstandings; and will discuss various therapy options in given hypothetical situations. http://health.groups.yahoo.com/group/paediatrics
> To: drdoctor@hotmail.com
> Subject: Feedback via the Ask Health Query to Dr SK. Get answered for free.
> From: burst@emailmeform.com
> Date: Fri, 16 Oct 2009 11:45:28 -0400
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> > > Visitor Ip: 118.103.233.132
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