A 9-year-old boy named Raju presented with decreased playfulness, shortness of breath, tingling and numbness, and paleness of skin, over the course of a month. His clinical examination revealed signs of anemia, possibly due to nutritional deficiency, specifically megaloblastic anemia. He has no significant past medical or family history and is from a moderate socioeconomic background with a strict vegetarian diet.

1. CASE PRESENTATION

2. 🞆 A 9 year old male child by name Raju, resident of
Indrapalem, Kakinada was brought to the
hospital by his mother who is tailor, who can
read and write and her reliability of her
information is good.
. CHIEF COMPLAINT:
- Decreased activity of playfulness since 1
month
- shortness of breath on exersion since 15 days
-Tingling and numbness since 10 days
- Paleness of skin since 8 days

3. HISTORY OF PRESENT ILLNESS:
According to the mother the child was apperently normal 1 month
back , then he developed :
- Decreased activity of playfulness
Onset :Insidious
Duration :1 month
Progression: gradually progressed
Associated with :Irritation
- Shortness of breath
Onset :Insidious
Duration :15 days
Progression :gradually from Grade 1 to grade 2
Relieved on:Taking rest
-Tingling and numbness
Onset :Insidious
Duration :10 days
Progression :gradually progressed initially Involving fingertips
now progressed to hands

4. -Paleness of skin:
Onset: Insidious
Duration: 8 days
Progression: gradually progressed
🞆 Associated with: fatigue
🞆Not H/o fever and lymphadenopathy
🞆Not H/o nausea ,vomiting , malena,
constipation, abdominal pain
🞆No H/O weight loss
🞆No h/o increased sensitivity to cold

5. SYSTEM REVIEW
CVS: No h/o chest pain, palpitations, cyanotic spells, no pedal edema
Respiratory system: no h/o productive cough and wheezing, fever
GIT: No h/o pica,melena, constipation , diarrhoea
CNS: no signs of meningitis, no altered sensorium, no disturbance of sleep
behavior and consciousness and paraesthesia of fingers present
Musculoskeletal: no h/o joint pains
Genito urinary: no h/o hematuria no h/o pain with micturition
Hematological: H/o early fatigability [decreased duration of playfullness]
h/o dyspnea on exertion present
Skin: pale skin, no rashes, no petethiae
RES: no h/o bleeding gums

6. PAST HISTORY:
🞆No h/o similar complaints in the past
🞆No h/o tuberculosis, Bronchial asthma, Epilepsy,
Jaundice
🞆No h/o repeated blood transfusions
🞆No h/o previous surgeries

7. PERINATAL HISTORY:
🞆 ANTENATAL HISTORY: (obstetric formula – G2P1L2)
🞆 Age of mother at conception:20
🞆 Regular antenatal checkups done
🞆 IFA supplementation taken, 2 doses of TT taken
🞆 No h/o TORCH infections
🞆 No h/o radiation exposure, drug exposure
🞆 No complications during pregnancy
🞆 NATAL HISTORY:
🞆 Term gestation
🞆 Normal vaginal delivery at GGH, Kakinada
🞆 Birth weight: 2.8kg
🞆 Baby cried immediately after birth
🞆 POSTNATAL HISTORY:
🞆 No h/o neonatal jaundice, no h/o feeding difficulties

8. FAMILY HISTORY
🞆Non- consanguinous marriage
🞆No h/o similar complaints in the family
🞆No h/o TB contact and other infections

9. DEVELOPMENTAL HISTORY
🞆The child is studying in 4th
class.
🞆No developmental delay is seen.

10. IMMUNISATION HISTORY:
🞆 0 dose- bcg, opv, hep b taken
🞆 6,10,14 weeks - rota , penta, opv taken
🞆 6,14 weeks- ipv taken
🞆 9-12 months- MR1, jpe-1 taken
🞆 16-24 months-DPT1,MR2,OPV booster,JE2 taken
🞆 5-6 years-dpt 2 booster
SOCIO-ECONOMIC HISTORY:
Belong to class 4 according to modified Kuppuswamy
SES scale

11. DIETARY HISTORY:
The child is following strict vegetarian diet.
Milk and milk products are also avoided.

12. GENERAL EXAMINATION:
Conscious, coherent, co-operative
🞆 Pallor: Present
🞆 No signs of Icterus , cyanosis , clubbing , generalized
lymphadenopathy , pedal edema
🞆 VITAL DATA:
🞆 Temperature: 98.4°F
🞆 Pulse rate: 92beats/min, normal volume, no radio-radial
and radio-femoral delay, peripheral pulses present
🞆 Respiratory rate:18 breaths/min, abdomino-thoracic type
🞆 Sp02: 93% at room air
🞆 BP: 110/60mmHg in supine position, measured in left arm
🞆 Capillary Refill Time: 4 sec

13. ANTHROPOMETRY MEASUREMENTS
observed expected
height 131cm
weight 29kgs
MUAC

14. HEAD TO TOE EXAMINTION:
Head: shape and size are normal
Eyes: eyelids, eyebrows, eyelashes are all normal.
Nose: nose bridge and philtrum are normal.
Mouth: Lips palel, buccal mucosa pale, tongue is
beefy red.
Neck: no swellings
Upper and lower limbs normal
Skin-hyperpigmentation of skin at knuckles mainly
of interphalanges in the dorsum of hand.
Genitalia - normal
Spine - no deformity

15. SYSTEMIC EXAMINATION
🞆Cns:
🞆Handedness:right
🞆Higher mental function, speech, cranial nerves,
motor system :normal
🞆Reflexes, posture:normal
🞆Sensory examination :vibration and positional
loss
🞆Spinal and cranial
examination ,extrapyramidal, cerebellar
disease :normal
🞆Peripheral nerves examination :normal
Examination of meninges :no signs of meningeal
irritation that is neck stiffness, kerengs signs, brugisiki
sign :normal

16. OTHER SYSTEMS EXAMINATION
CVS- S1 and S2 are heard
no added adventitious sounds
No murmurs and thrills
Respiratory- Trachea in midline
Normal vesicular breath sounds
Hematological- Signs of anemia seen at buccal
mucosal, palpeable conjunctiva, red beefy tongue,
hyperpigmentation of skin
Lymphatic- No lymphedenopathy
Per abdomen -Soft and non tender, No
organomegaly, Bowel sounds present

17. PROVISIONAL DIAGNOSIS:
🞆A 9yr old male child raju came with chief
complaint of decreased activity of playfulness,
shortness of breath, tingling and
numbness,anaemia probably a anaemia due to
nutrional deficiency (megaloblastic
anemia )with no other complications.

18. THANK
YOU