3 years old male baby history of on off fever since 1month, antibiotics and analgesics given.sypmtoms relieved. 5days back fever came again mod to severe, mild pain abdomen usg done showing around 12 mesenteric lymph nodes enlarged, since 5 days patient is being treated but after every 6 hrs high grade fever appears, mantoux done negative, cbc done showing lyphompenia and raised esr widal not reactive rest investigations normal. Then patient was talken to ent specialist he did xray naso pharynx which showed adenoid hypertrophy and otitis media with effusion on otoscopy. Fever is still coming after pcm effect finishes that is after every 6 hrs. Need your suggestions please how to proceed further


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OME per-se is a chronic Non-infective middle ear pathology with sterile exudates. AOM can cause persistent fever with Secondary mastoiditis, abcess, lateral sinus thrombosis, meningitis, encephalitis. Suggest HRCT Temporal bone with brain/ MRI Lumbar puncture for CSF analysis Blood for C&S @Dr. Showkat Parray

Calc Iod 0/1.....

This case may be a case of antibiotics fever. Stop all antibiotics, record temp. 6 hrly. Note the pattern of fever for three days. Then investigate afresh and treat accordingly

1 month fever on and off responding to antipyretic but coming back with mesenteric lymhadenopathy and OME and adenoid enlargement with ESR high .all culture are negative .it look like more inflammation rather infection .more like infection would be brucella or tb or infectious m. Or cause of comlication could abd abscess .

Stop all medicines and observe the pt. for 3 days. Only give pcm sos. If no improvement go afresh with the investigations

Adenoid hypertrophy Not a reason for fever R/O TB, Lymphoma, Typhoid, blood cultures

All things ruled out

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Mesenteric lymphadenitis is usually due to self limited viremia which also causes neck gland hypertrophy In fact it affects lymphatic tissue throughout body Also known as tonsil tummy Itz self limited So treat with PCM n wait n watch for few days

N effusive otitis media will settle once adenoid hypertrophy resolves

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Agreed with Dr Murari. Serous otitis media is sterile condition but as it is one focus found till now so go for temporal bone HRCT to look for hidden focus.

Kindly mention the size of abdominal lymphnodes. Many a times nonsignificant LN are mentioned. Transaxial diameter more than 20 mm shld be considered significant. How is the GC of pt? Is there any weight loss?

Sir, As from my on experience, stop antibiotics, &set him on Pcm with prednisolone in tapping dose with Lumafantrine syp in proper dose, I think definately you will get the result positive.

Do urine r/e n c/s . R/o autoimmune disordera

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