Viral Hemorrhagic Fever - Pediatric Oncall

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Rakesh Kumar, Puja Bhagat Department of Pediatrics, Katihar Medical College, Katihar, Bihar, India ...

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	Specialist Answers
Question
An 8 yr old girl,weight 30Kgs, apparently in a healthy condition, developed low grade fever for 3 days associated with nausea and 3-4 episodes of vomiting. She was advised ofloxacin and domperidone by a local pediatrician. Fever did not respond well to these medications and a repeat advice was sought and was asked to continue the same. On day 3, she started complaining of 'Burning sensation' in feet and wouldn't allow anyone to touch them and would feel comfortable with application of cold. Her extremities were cold & for this unusual complaint, was taken to a hospital where she was admitted for observations and some IV fluids were administered. Two hours following infusions, she developed agitated behavior and on examination her blood pressure was found to be progressively falling and hence was shifted to ICU. ECG done showed Ventricular tachycardia and despite adequate intervention succumbed to her illness. All her investigations were within normal limits including electrolytes. No history of diarrhea, oligouria, any congenital anamolies, birth injuries or cardiac complaints , previous hospitalization.
Answer
One should rule out conditions such as viral hemorrhagic fever especially dengue since she had myocarditis (ventricular tachycardia), shock (progressive hypotension) and fever and vomiting. Other conditions such as demyelinating disorder with infections should be ruled out. What was her renal function tests and liver functions test? Also was her neurological examination normal? Details about that would be useful. Back to All Questions

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