Clinicopathological Conference Report

A one-year-old girl (resident of Bhatinda, Punjab) was first admitted at PGIMER under pediatric hematology-oncology at the advanced pediatric center on 05.10.2011 with complaints of fever and progressive abdominal distension for 1 and a half months. Fever was intermittent, associated with occasional vomiting and documented up to101°F. Vomiting was nonbilious and nonprojectile. She also had progressive pallor for 1 month, which was not initially associated with jaundice, edema or bleeding manifestations. She reported weight loss of 500 gm over 10 days. Patient was worked up for the possibility of hemolytic anemia and storage disorder and discharged on 08.10.2011. She received one unit packed red cell transfusion on 12.10.2011, following the bone-marrow, done on OPD basis. She was readmitted at PGIMER on 20.10.2011 in pediatric emergency for the same complaints, with new onset cough and coryza for 7 days and fever with respiratory difficulty for 5 days. She was born through nonconsanguineous marriage, at term and weighed 1500 gm at birth. There was no birth asphyxia and her development milestones were appropriate for age. Her two elder siblings, both girls are asymptomatic. There was no apparent history of contact with tuberculosis patient.