Vasculitis

3. DR ABDUL JABBAR
MCPS TRAINEE
UNIT 3
26-07-17
MORNING MEETING

4. 06 years Nawab weight 12 kg resident of Larkana admitted through ER on 16-07-17
 Presenting Complain:
Fever for 15 days
Rash for 08 days

5. HOPC

6. HOPC

7. HOPC

8. HOPC

9.  Past history :- not significant.
 Drug history :-
 Birth history:-
 SVD, FULL TERM, NBW, Home delivery.
 Feeding history:-Exclusive breast feeding till 6 months. Weaning
started at 6 months. Now takes 900 calories.

10.  Developmental history :- achieved all milestone according to age.
 Vaccination history :- vaccinated acc: to EPI schedule. BCG scar
present.
 Family history :- 1st issue of consanginous marriage. No h/o blood
transfusion, bleeding disorder or any other chronic illness in family.
 Socioeconomic history :- poor class.

11. General physical examination
 Well oriented, irritable child with no obvious respiratory distress and
dysmorphic facies.
 A+ve, J-ve, CL-ve, D-ve, ED+ve, LN-ve
 VITALS :-
Temp 98F
R/R 26 b/min
H/R 115 b/min
B.P 108 /70 mmhg 95 th centile

12. Anthropometry
 Length 100 cm 3rd centile
 weight 12 kg < 5th centile
 FOC 50cm 25th centile

13. Systemic Examination;
 CNS
 Respiratory
 Abdomen unremarkable
 CVS

14. DIFFERENTIAL DIAGNOSIS
 Auto immune vasculitis
 Protein C,S deficiency
 Connective tissue disorder
 Meningococcemia

15. INVESTIGATIONS

16. CBC 16-07-17
Hb
Hct
Mcv
Mch
Mchc
8.7 g/dl
25 %
66 fl
28 pg
32 g/dl
Wbc 22300
Neutrophil 87 %
Eosinophil 2 %
Lymphocytes 10 %
Monocytes 1 %
platelets 719
ANC 19401

17. URINE D/R
PHYSICAL
Quantity 20ml
Colour Yellow
SP.gravity 1.025
Ph 6.5
CHEMICAL
Albumin Trace
MICROSCOPIC
Wbc 8-10
Rbc nil
Epithelial cell occ
Crystal nil
Cast Granular (+)
Remarks Nitrates ( nil ) Blood ( nil ) Leukoctye (+)

18. Biochemistry 16-07-17 19-07-17
Urea 20 mg/dl 25 mg/dl
Cr 0.3 mg/dl 0.3 mg/dl
Na 132 meq/l 138 meq/l
K 4.0 meq/l 3.7 meq/l
Cl 98 meq/l 95 meq/l
HCO3 24 meq/l 22 meq/l
ALBUMIN 3 G/dl 3.1 G/dl

19. 16-07-17 TEST CONTROL
PT 14 sec 14 sec
APTT 34 sec 34 sec

20. 18-07-17 RESULT Ranges
Serum C3 1.46 g/l o.8 -1.5
Serum C4 0.47 g/l 0.12 -0.36

21. 20-07-17
Stool occult Blood Negative
20-07-17 Result Ranges
Plasma Homocysteine 17.20 umol/l 5 - 12

22. ANA PROFILE (ANA,AMA,ASMA)
 ANA NEGATIVE
 AMA NEGATIVE
 ASMA NEGATIVE

23. HB ELECTROPHORESIS
Result Ranges
HBA 96.9% ( 96.5 - 98.5 )
HBA2 3.1% ( 1.5 - 3.5 )

24. X-RAY Chest

25. Ultrasound Abdomen
 Impression:
 Normal scan of abdominal viscera.The liver & Kidneys do not show
any textural changes.
 Portal vein appears patent with normal flow pattern & respiratory
variation. ( Doppler Finding ).
 No evidence of any significantly enlarged lymph nodes,bowel wall
thickening,ascites,varices,mass,intussuception or collection noted.
 Both adernals appear normal.They do not appear echogenic or
prominent.

26. Colour Duplex sonography of artries & veins of both Arms
 Impression:
 No plaque formation or occlusion is seen in arteries of both arms.
 No evidence of thrombosis found in the veins.
 No definite evidence of any joint effusion or collection noted.
 The digital vessels cannot be evaluated.

27. Colour Duplex Sonography of artries & veins of both LEGS
 Impression:
 No plaque formation or occlusion is seen in arteries of both legs.
 No evidence of deep vein thrombosis in both legs.
 Symmetry is noted in Doppler scans of both legs.
 No definite evidence of any joint effusion or collection noted.
 Doppler scan till dorsalispedis artery of both legs appears
unremarkable.
 small digital vessels of lt. leg could not be evaluated.

28. ECHO
 FINAL ECHO DX:
 No significant cardiac abnormality.
 Minimal Pericardial effusion.

29.  Blood C/S : No bacterial growth.

 Anti cardiolipin IGG
 Anti cardiolipin IGM
 Protein - C Awaited 30 -07-17
 Protein - S
 Anti Thrombin III

30. Hospital Management
 Orally Encouraged.
 Inj: Provas 120 mg iv 1* 6 hr.
 Inj: kinz 1 mg iv 1* 6 hr.
 Inj:0.45% D/S 1100 ml iv 1* 24 hr.
 Inj: Clexane 6 mg s/c 1 * BD 5 Days.
 Inj: Dexa 2.5 mg iv 8 hr.

31. FINAL DIAGNOSIS