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unusual presentation of neuroblastoma
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A 4 Yr. Old, Male, Hindu Pt. , Residing At
Gandhidham,
Admitted With Complaints Of
Fever For 2 Days
Cough For 5 Days
Pain In Abdomen For 4 Days
Weakness Of Lower Limbs For 2 Days
8/4/2010
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Fever-----low Grade, Intermittent, Without
Chills And Rigors,relieved By Oral
Medications.
Cough-dry, no paroxysm, no breathlessness
Abdominal Pain----dull, intermittent ,Not
Radiating, relieved By Itself
Weakness Of Both Lower Limbs---not Able To
Walk
8/4/2010
3
No H/o trauma I. M. Injection ,recent vaccination
bleeding from any site Vomiting ,frequency of stoolEar discharge Convulsion or altered sensorium dog bite
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No H/O Similar Episodes In Past. Family History –Not Significant Birth History– Uneventful Immunization History—complete For Age Development H/O –Normal For Age no Regression Of Developmental
Milestones
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Treatment Taken Before Hospitalization Tab. Prednisolone For 2 Days Investigations Are Hb—6.4 TC—3300 DC 30/68/1/1 Platelets-1,70,000 PS For MP- Not Seen
8/4/2010
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Conscious, oriented To Time ,Place ,Person, follows Verbal Commands
Weight 15 KgTemp. NormalH.R.-102/Min B.P.-106/58 mm of HgPallorNo LymphadenopathyNo IcterusNo Clubbing
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R.S.-Right Few Lower Zone Crepitations
CVS-NADP/A; No Organomegaly., No Lump
Or Mass Palpable
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CNS:ConsciousNo Cranial Nerve PalcyNo Signs Of Raised I.C.T.Pupils Round And Reacting To LightTone Decreased In Both Lower LimbsPower—5 In Both Upper Limbs And 0 In
Both Lower limbs
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Abdominal Reflex –AbsentKnee Reflex----absentPlanter– AbsentScrotal—absentAnal—absentSpine Normal No Neck Rigidity
8/4/2010
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Hb-8 Gm TC—7000 DC—55/40/4/1 Platelets-5,20,000 Microcytic,hypochromic Anaemia PS For MP Not Seen Bld.Urea—17 S.Creatinine-0.6 S.Na+--138 S.K+--4.6
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8/4/2010
X-ray Chest Suggestive Of Rt. Lower Zone ConsolidationX-ray Of Dorso Lumbar Spine Is NormalS.Widal NegativeAso- Positive
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Pt. Had lost bowel bladder control No Fever Cough Perssisted
Considering GBS Inj.METHYL PREDNISOLONE Started On 2nd Day Of Admission.
8/4/2010
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Inj. Methyl Prednisolone For 1 DayNext Day Pt. Improved Markedly In The Form
Of Lower Limb power Is 4/5.On 3 th Day Of Admission Pt. Had acute
Abdominal PainSubsided By Analgesics. And Ranitidine
Adviced For USG Abdomen
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8/4/2010
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6*8 Cm Sized,heterogenous Echotexture Lesion With Internal Calcification Mass Anterior And Superior To Kidney,which Engulf Major Vessels
Multiple Enlarged Para Aortic And Retrocaval Abdominal Lymphnodes.
8/4/2010
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Altered Signal Intensity Soft Tissue Lesion Left Para-spinal Region Extending In Post.Epidural Space From D1 To D9 And D12 To L4 Vertebra levels .Complete Epidural Block At That Level
8/4/2010
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SMALL ROUND CELL TUMOUR- NOT LYMPHOMA
NEUROBLASTOMAWILM’S TUMOUR
8/4/2010
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BONE MARROW INVOLVED BY MALIGNANT ROUND CELL TUMOUR
NSE-POSITIVE CD99-POSITIVE NF-POSITIVE DIAGNOSIS ?
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NEUROBLASTOMA
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