Ten and a half year old girl with a very pleasant personality, presently student of standard IVth weight 46 kgs, height 140 cms with no significant previous medical or surgical history.she was born by LSCS as her mother is hypertensive 3 weeks before the EDD. At birth APGAR score was normal n weight was 3 kgs. Family history: Father is diabetic for last 3 years, on OHA, sugar under control Mother is hypertensive n she is on tab amlodipine 5mgs OD .BP under control. The child was apparently well till October 2007 , then she developed, fever uoto 103 degrees F . Loose motion pain in the abdomen , periumbilical, non radiating , non spasmodic, not associated with nausea and vomiting. She was treated by a pediatrician and she was adviced broad spectrum antibiotic, antispasmodic symptomatic treatment. The fever subsided in a week. and also the abdominal pain subsided. She again developed pain in the abdomen in February 2009, periumbilical in location , no radiation , not associated with nausea and vomiting. The pain was worse at night. She was consulted to the pediatrician and she was advised PPI, antispasmodics, digestive enzyme and multivitamin. Ultrasonograpy of the whole abdomen and pelvis dated 01.012.2009 showed Hepatomegaly cranicaudal diameter 11.4cms, mild periumbilical probe tenderness.Gallbladde, Pancreas, RIF, uterus and ovary normal. There was no lymphadenopathy. Routine examination of stool 03.02.2009 : WNL Urine culture and sensitivity : E.Coli sensitive to aninoglycosides, 4-quinolone, macrolide and cephalosporin. She was prescribed Inj Ceftriaxone 250 mgs BD for 5 days. CBC15.07.2009 : TLC- 8900/cmm Neutophils -75% ESR:Average 31 LFT and KFT: WNL As the periumbilical pain does not resolve she was seen many pediatricians and GPs. She was also advived antidepressant and antipsychotic in view of ? malingering but she did not take that. ELISA for KOCh’S - IgM03.03.2009 : 0.81 Reference range <0.8 : negative 0.8-1.0 : borderline. >1: Positive She was started on ATT tab rinizid fort DT Rifampicin ip-150, Isoniazid ip-100, Pyrazinamide ip-500 from 17.04.209 for a nine month course ended on 12.01.2010. The pain persisted during the course of ATT but the intensity slightly lower. She tolerated the ATT well. LFT was regularly done which was WNL. Ultrasonography of whole abdomen and pelvis 21.09.2009: Mesenteric and paraaortic lymphadenitis , otherwise normal scan. On 20.04.2009: Mycobacterium tuberculosis was not detected in the blood done by Real time PCR method She was seems here by an eminent Gastoenterologist who adviced a BMFT to be done which was found to be normal .She was adviced PPi and anti helminthic Albendazole Ultasonography of whole abdomen and pelvis 11.03.2010 :No hepatospleenomegaly , Few small mesenteric lymphnodes likely to be non specific. Contrast enhanced CT scan of whole abdomen and pelvis 06.05.2010: Few subcentimenter size lymadenopahy likely to be non specific. liver, GB, pancreas, B/L Kidneys, small bowel, large bowel normal. No RIF inflammation. Urinary bladder normal. Presently on examination: Conscious. Oriented , afebrile, mild obese previous thyroid profile WNL Pulse-97.8 degrees F, Pulse 90/mt regular, BP-100/70 mm Hg , RR-18/mt No pallor, edema, icterus, clubbing, cyanosis, lymphadenopathy, JVP WNL CVS/CNS/CHEst: Normal P/A: Soft , no rigify or guarding , mild periumbilical tenderness Bowel/Bladder/appetite/sleep: Normal Presentlyeriumbilical pain mostly in the morning hour, not associated with nausea or vomiting or belching or acid brash. Slight relief on passing stool. What is your opinion? thanks n warm regards. dr chnadan
