A CURIOUS ATYPICAL CASE

a 3 year 26 yrs old boy 13.6 at thin presented with cough started first cough continues with fever second day rt side neck lymphadenitis 2nd day antibiotic amoxiclav BD given 1day azithromycin given paracetamol syrup 6thhrly mefanamic p given 8th hrly macberry syrup same continued 1 day more rashes started in palm , lymphadenitis area , on basic investigations HB 10.6 TC 9000. NEUTROPHILS 82% ESR 96 SCRUP TYPHUS , MP QBC , TYPHOID , DENGUE DOT TESTS NEGATIVE hepatosplenomegaly seen 4th day fever spikes started from day 3 till day 4 treated symptomatically only with tepid sponging vomiting started day 4 projectile two times after that , baby has been dehydrated , decreased response iv fluids started iv doxycycline given patient shifted to Pediatric hospital immediately if fluids started meropenam iv started investigations HB 9 TC 9000 NEUTROPHILS 80% PLATELETS 1.2LKS NEXT DAY USG ABD SHOWS HEPATOSPLENOMEGALY CONFIRMED MILD ASCITES DAY 7 PATIENT STILL BAD ONLY INVESTIGATIONS SENT WAS CBC RFT LFT AGAIN FEVER PROFILE HB 10 TC 11000 NEUTROPHILS 50% EBV SWRO NEGATIVE DENGUE IG TEST NEGATIVE BLOOD CULTURE AWAITED KINDLY TELL OR DISCUSS DIFFERENTIAL DIAGNOSIS I WOULD START WTH EBV ATYPICAL SCRUB TYPHUS KAWASAKI

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I would rather say we are very close to post antibiotic era . In a span of few days patient was given every antibiotics possible . Theres neutrophilia and esr is elevated . Was he examined for tonsillitis. Was uti ruled out . Was weil felix test done to r/o scrub typhus . Wheres crp and procalcitonin. Atleast a blood c/s was sent . For kawasaki there should be fever for more than 5 days non purulent conjuntivitis strawberry tongue swelling of limbs. There should be thrombocytosis in second week. Was there any history of rashes . Though with treatment neutrophilia has resolved . Wait for blood c/s . Do echo if u r highly suspecting kawasaki disease to r/o coronary artery disease like aneurysm .
Tonsillitis examination done on 8th day its present Weill felix test not done only agm test done reports awaited infection specialist sent for brusellosis hepatitis a Repeat usg ordered for any cholestatic abnormality Repeat CBC showed similar value as before except crp has decreased courtesy antibiotic pct not done sir Feature are not classical of Kawasaki except red jor cherry red tongue and lips ,lymphadenitis, hepatosplenomegaly,, rashes
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Dengue ebola IM ricketesial ALl ae dds
Sir what about KAWASAKI sir Yes sir most of symptoms features looks like rickestsial disease
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??Kawasaki ??EBV?? Brucellosis

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