HIV in Children
GRAND ROUNDS AND TEACHING FILES
Loculated pleural effusion
Ira Shah, Rishika Kasaria
Medical Sciences Department, Pediatric Oncall, Mumbai, India.

A 13 years old girl presented with intermittent fever for past 3 months. She was admitted twice for same and treated for enteric fever. She has loss of appetite since past 2 months along with vomiting for 15 days. There was no contact with a patient suffering from tuberculosis. She was immunized till date and milestones were normal. On examination, height was 147 cm and weight was 34 kg. There were no lymphadenopathy or pallor and vital parameters were normal. On systemic examination, she had ascites. Other systems were normal. Investigations showed hemoglobin of 10.9 gm/dl, white cell count of 7,500 cells/cumm and ESR of 85 mm at end of 1 hour with platelets of 4,82,000/cumm. Ultrasound abdomen showed septations in intraperitoneal fluid with omental thickening with enlarged lymph nodes in periportal, peripancreatic region, largest being 3 x 1.7 cm. CT abdomen showed large loculated ascites with loculated collection of 5.4 x 4.5 cm in right retrovesical region in right adnexa with clumping of bowel loops and mildly enlarged external iliac lymphnodes. Ascitic tap showed uncountable pus cells. Ascitic fluid adenosine deaminase (ADA) was elevated 343 U/L and tuberculous bactec culture at end of 6 weeks grew mycobacterium tuberculosis (MTB) complex. Her tumor markers of serum alpha fetoprotein and CA-125 were normal. HIV ELISA, ANA, double stranded DNA were negative. Mantoux test was positive and Chest X-Ray was normal. She was started on 4 drug anti-tubercular therapy (ATT) and shifted to 2 drugs after intensive phase of 2 months. She completed 12 months of ATT and ultrasound of abdomen was normal at end of therapy. She had gain 12 kg in the one year of therapy.

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