13 year old boy came with yellowish discolouration of eyes nd yellowish discolouration of urine, yellow green vomiting.

CHIEF COMPLAINTS:-

A 13yr old boy came to opd with chief complaints of yellowish discoloration of the eyes,

yellowish green coloured vomitings and also had yellow coloured urine since 9 days.

Patient history :

AT BIRTH:

Patient developed jaundice and it resolved spontaneously.

AT 8 MONTHS:

He had altered bowel movements ,for 1 week he had loose stools and another week he

had normal consistency.later he had loose stools every day for 2-3 days during which he

became cachexia.He got admitted in hospital and they mentioned as suspected case of

celiac disease,chronic diarrhoea,chronic malabsorption. He was treated with IV

antibiotics and 2 FFP transfusions. He recovered within 3 months.

He also had recurrent attacks of cold,cough and fever.He used inhalers for 1 year during

winters.

AT 9 YEARS:

He had neck swelling and diagnosed with hypoth yroidism (Initial TSH levels-150).He was

started with THYRONORM 150 mcg which later increased to 180 mcg.

He also had chronic itching over hands and foot since the age of 9 years.

AT 12 YEARS:

He had chickenpox and resolved within 10 days.

AT 13 YEARS(Now):

He came with complaints of yellowish discoloration of eyes ,dark yellow colour urine

since 9days.Also had one episode of bilious vomiting.

No history of fever,chills,abdominal pain,loose stools,c old ,cough,joint pains.

FAMILY HISTORY:

He is a 4th order child ,born out of grade 4 consanguinous marriage

He has 2 elder brothers and one elder sister - who expired at 5 years of age .

His sister was the first child and she was asymptomatic till 2 years of age ,then she had

shortness of breath and was rushed to hospital,where here condition deteriorated and

got admitted .They were told that she had splenomegaly and Her blood counts were

decreasing .She was given multiple blood transfusions every 25 days for one year in

spite of that she remained anaemic ,she also underwent bone marrow biopsy twice .

According to parents she was given steroids also for one year before death .she never

had jaundice or recurrent infections.

.Elder brother is 19 year old and second brother is -16 years old .

Second one had history of fever ,white coloured loose stools at the age of 5 years ,for

which they went to Nalgonda hospital .He was given some medications and it got

resolved .But he was said to have anaemia ,and he recovered according to parents with

some medications.There was no jaundice and no history of blood transfusion.

PERSONAL HISTORY

Diet:mixed

Appetite:normal

Sleep:normal

Bowel and bladder movements:regular

No addictions

GENERAL EXAMINATION

Patient is conscious, coherent and cooperative.

Pallor-present

Icterus-present

Cyanosis,Clubbing,Lymphadenopathy, oedema-Absent

VITALS:

Temp:afebrile(98.6°F)

PR:90 bpm

RR:22cpm

BP:120/70mmHg

SYSTEMIC EXAMINATION:-

CVS:S1,S2 Heard shift in apex beat to 4th ics

RS:BAE+

CNS:NAD

P/A: Abdomen is distended and spleen is palpable.

INVESTIGATIONS:

Coombs test :- 

PROVISIONAL DIAGNOSIS:

SPECTRUM OF AUTOIMMUNE DISEASE-THYROIDITIS.

AIHA(AUTOIMMUNE HEMOLYTIC ANAEMIA)

CVID

TREATMENT:

TAB.METHYLPREDNISOLONE 32 mg PO/OD

TAB.THYRONORM 200 micrograms PO/OD

Monitor vitals for every 4 hrs.