Question

A 3-year-old black girl was taken to the emergency department by her mother because of an elevated temperature that could not be controlled by aspirin. The mother also reported that her daughter had been crying, pulling at her ear, and complaining of a sore throat for the past several days.

Physical examination revealed a well -nourished but listless child. The tympanic membrane was infl amed. The child had both lymphadenopathy and hepatosplenomegaly. The emergency department physician ordered a STAT CBC.

■ Laboratory Data
The child’s erythrocyte count and hemoglobin level weresubstantially below normal. The total leukocyte count was 66.0 × 109/L. Leukocyte distribution on the differential smear was as follows:

Blast forms 76%

Prolymphocytes 12%

Lymphocytes 12%

The blast cells had one to two nucleoli and a high nuclear-cytoplasmic ratio. The nuclear shape of the blasts was round, and no Auer rods were seen in the cellular cytoplasm. The number of platelets (thrombocytes) was severely decreased.

Subsequent cytochemical examination revealed a strongly positive PAS reaction on the bone marrow lymphoblasts. The Sudan black B and esterase cytochemical stains were negative. Additional immunological testing revealed that the lymphoblasts exhibited a common ALL surface marker phenotype.

■ Questions

1. What is the most probable diagnosis in this case?

2. What additional tests could be done?

3. What is the prognosis?

Answer 1

1. Diagnosis is Otitis media.Ear infections happen when viruses or bacteria get into the middle ear, the space behind the eardrum. When a child has an ear infection (also called otitis media), the middle ear fills with pus (infected fluid). The pus pushes on the eardrum, which can be very painful
2. otoscope. A healthy eardrum will be pinkish gray in color and translucent (clear). If infection is present, the eardrum may be inflamed, swollen or red.

• check the fluid in the middle ear using a pneumatic otoscope blows a small amount of air at the eardrum. This should cause the eardrum to move back and forth. The eardrum will not move as easily if there is fluid inside the ear.

Anothertest, tympanometry, uses air pressure to check for fluid in the middle ear. This test doesn’t test hearing. If needed, your healthcare provider will order a hearing test, performed by an audiologist, to determine possible hearing loss .

3.​​​​​Prognosis:

Most ear infections will initially be treated with either antibiotic ear drops or antibiotics taken by mouth. When the infection is severe, admission to hospital may be necessary for antibiotics via a drip. In some complicated cases surgery may be the best form of treatment.Once on antibiotics, your child will get better in 2 or 3 days. Make sure you give your child the antibiotic as directed. The fever should be gone by 2 days (48 hours).

The ear pain should be better by 2 days.This infection can result in damage to the bone and the formation of pus-filled cysts. Rarely, serious middle ear infections spread to other tissues in the skull, including the brain or the membranes surrounding the brain (meningitis). Tearing of the eardrum. Most eardrum tears heal within 72 hours.