A 12 y old boy complained of tiredness and not feeling well. His mother noticed that...

A 12 y old boy complained of tiredness and not feeling well. His mother noticed that his eyes and skin were kind of yellowish. She took him to the clinic for examination. A CBC and a urinalysis were done. Results were as follows:

Chemical analysisPhysical analysis

pH 5.0dark urine (brownish)

All negative except bilirubin

Microscopic unremarkable

CBC: Slightly elevated leukocytes with lymphocytosis

RBC normal

What is the most likely diagnosis? Justify your answer

What other tests would you recommend to verify your diagnosis?

Solutions

Expert Solution

Answer :

Two differential diagnosis we have to consider

a. Viral hepatitis b. Typhoid

Dark colored urine with jaundice is indicative of viral hepatitis. Lymphocytosis also implies viral etiology. Leucopenia can also occur.

Close differential diagnosis is typhoid. But neutropenia or leukopenia is more probable. Typhoid in children presents more as fever and vomiting that a sole jaundice presentation. Also thrombocytopenia is a common finding.

Fatigueness can be a presentation in both. Age is more in favour of typhoid. Leucocytosis can occur in initial stages of typhoid than viral hepatitis.

So further investigations should be

a. SGOT, SGPT

b. Card test for Hep A, C, B

c. S. Bilirubin total, conjugated and unconjugated

d. Widal/typhi.M

e. USS abdomen to assess hepatitis

The symptoms are more in favour of Typhoid than viral hepatitis. In favour of typhoid are initial leucocytosis, age and relative lymphocytosis.

Brown coloured urine is more in favour of viral hepatitis. Relative lymphocytosis also favour viral etiology.

gladiator answered 1 year ago

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