DEPARTMENT OF PAEDIATRICS

& CHILD HEALTH

FACULTY OF CLINICAL
SCIENCES
COLLEGE OF HEALTH SCIENCES
UNIVERSITY OF ILORIN, ILORIN

CASE REPORT SUBMITED BY

MATRIC NO: 10/48KC074
IN PARTIAL FULFILLMENT OF THE
PAEDIATRICS AND CHILD HEALTH
POSTING
JULY 2015

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TABLE OF CONTENTS
Title page
Table of contents
Outline of Case reports
Case report 1
Case report 2
Case report 3

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OUTLINE OF CASE REPORTS

Biodata
Presenting complaints
History of presenting complaints
Past medical history
Prenatal, natal and post natal history
Nutritional history
Immunization history
Developmental history
Family and social history
Review of systems
Summary
Examination
Assessment
Plan
Follow up.

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CASE REPORT 1
nd

DATE: 22 June, 2015

NAME:
ABDULLAHI Fatimah
AGE:
29 months
SEX:
Female
HOSPITAL NUMBER: 598402
RELIGION:
Islam
ADDRESS:
Isale-Koko, Ilorin
TRIBE:
Yoruba
INFORMANT:
Mother
Information received is considered reliable
PRESENTING COMPLAINTS
Fever.3 days prior to presentation
Cough2 days prior to presentation
Convulsionat presentation
HISTORY OF PRESENTING COMPLAINTS
Patient was in her usual state of health until about 3 days prior to presentation
when she developed fever. Fever was high, intermittent, worsens at night,
relieved transiently by tepid sponging and Paracetamol. Fever is associated with
rigors.
Cough started about 2 days prior to presentation. Cough was continuous
associated with nasal discharges. No history of coughing out of blood, no
vomiting after coughing, no coughing adult in household, no bluish
discolouration of lip, no history of forceful feeding and cough is not severe
enough to wake child from sleep. It however subsided a day prior to
presentation.
Convulsion was on presentation, patient had two episodes of generalized tonicclonic convulsion, duration of each was said to be less than 5 minutes upon the
administration of Phenobarbitone. Interval between convulsion episodes
couldnt be ascertained, there was associated loss of consciousness during the
episodes of convulsion and then a post-ictal loss of consciousness and she was
still unconscious. Convulsion was associated with defecation and urination into
Pampers. There was no history of neck stiffness, photophobia and seizure.

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PAST MEDICAL HISTORY

No history of previous hospital admissions or blood transfusion or surgery. No
history of similar illness in the past, not a known asthmatic. Haemoglobin
genotype is unknown, genotype of parents too are not known, however, there
was no history of hand and foot swelling.
PRENATAL, NATAL AND POST NATAL HISTORY
Mother was regular on Antenatal Visits, booked at Civil Service Hospital, Ilorin
and not a known hypertensive, diabetic. No rash or febrile illness during
pregnancy. Pregnancy was at term (about 38 weeks), delivery was through a
Spontaneous Vertex Delivery at a Civil Service Hospital. Patient cried
spontaneously after birth, no history of yellowness of eyes during the first
month of life.
NUTRITIONAL HISTORY
Patient was exclusively breastfed for 6 months, complementary feeds till 1 year
4 months after she was weaned into the family diet.
DEVELOPMENTAL MILESTONES
She gained neck control at 3rd month of life, sat without assistance at 7 months,
stood without assistance at 11 months, was able to walk at 1year 3 months (15
months) of life.
IMMUNIZATION HISTORY
She is fully immunized for age according to the National Programme on
Immunization (NPI) schedule evidence by the award of a certificate on
completion.
FAMILY AND SOCIAL HISTORY
She is the second child in a monogamous family of 2 children. Recides with
parents and sibling in a Room and Palour apartment. Tap water is the water
source and method of sewage disposal is through the Water closet system.
Mother is a trader with O-level while father is a Civil servant with a Diploma.
REVIEW OF OTHER SYSTEMS
Cardiovascular system: No history of Paroxysmal Nocturnal Dysnoea or
Orthopnoea, no facial or leg swelling
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Alimentary system: History of passage of dark stool of 2 days duration, No

history of constipation, vomiting, diarrhea.
Genito-Urinary system: Urine colour was dark at presentation, no reduction in
urine output
SUMMARY
I have presented a 29 months old girl who came on account of fever of three
days duration, two episodes of generalized tonic-clonic convulsion at
presentation, there is associated post-ictal loss of consciousness and patient was
still unconscious.
GENERAL EXAMINATION
I found a young girl, unconscious, febrile (39.7oC), anicteric, pale, not
cyanosed, well hydrated, no significant lymph node enlargement, no pitting
oedema, no finger clubbing. She has nasal prongs and Intraosseous line around
the right upper leg in place.
Anthropometry
Occipito-frontal circumference (OFC) = 47 cm (92% of expected); Mid-Upper
Arm Circumference= 14 cm at 6cm from the acromium; Length = 79cm (86%
of expected); Weight= 10kg (77% of expected)
SYSTEMIC EXAMINATION
Central Nervous System: Unconscious, GCS of 8/15 (Eye opening3{spontaneous}, Verbal response-1 {none}, Motor response-4{withdraws from
pain}), signs of meningeal irritation (Brudzinski and Kernig signs) are negative.
Respiratory System: Chest is symmetrical, moves with respiration. Respiratory
rate=66 cycles per minute. Trachea was central, chest expands well with
respiration. Percussion notes in the lung zones on both sides were resonant.
Breath sounds are vesicular.
Cardiovascular System: No precordial budge or hyperactivity. No palpable
murmur (thrill). Heart rate = 150 beats per minute, Heart sounds: S1, S2 and S3.
Abdomen: Abdomen is full, moves with respiration, no visibly distended vein.
Liver is 6cm papable below the right costal margin, No palpable splenomegaly
and the kidneys are not ballotable.
Percussion note are tympanic but dull over the liver.

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INTERVENTIONS AT PRESENTATION
RBS= 2.5mmol/l. RDT= +ve. PCV= 38%.
ASSESSMENT
Cerebral Malaria (RDT +ve, hyperpyrexia, Shock, multiple convulsions within
a 24 hours period)
Plan: IVF Normal saline 20mls/kg over 30 mins. IV 10% Dextrose water
2ml/kg stat. IV artesunate 2.4mg/kg at 0, 12, 24, 48 hr.
Difficulties in securing IV access. Had an interosseous line set for that purpose.
Samples for FBC, E,U and Cr, Blood culture, urinalysis to be taken. IV access
was later gained, IV Rocephin 100mg/kg daily was later added to the
intervention. BP, SP02 was monitored at intervals. Input-output chart was made.
Urinalysis result: Blood 4+ Ketone 2+, Protein 1+, pH= 5, Leucocyte= 2+, SG=
1.020
On examination after 30 mins, pupils are dilated and reactive, generalized
hypertonia.
DAY 2 (23/6/2015)
Child has improved, now conscious but drowsy. Last episode of convulsion was
14 hours ago.
I V artesunate, IV ceftriaxone continued. Child was rehydrate at 5% deficit and
maintenance.
DAY 4 (25/6/2015)
Child was conscious, afebrile (37.2oc) but pale. Liver was 8cm below the right
costal margin, mid-clavicular line, soft, smooth and non-tender. Spleen was
enlarged, 3cm from LCM, mid-clavicular line.
On CNS: Neck stiffness, cortical blindness and generalized hypertonia.
Not had any episode of convulsion in the last 48 hours. Still on IV fluid, IV
ceftriaxone and artesunate. IV gentamicin added. TPR showed intermittent
fever with a downward trend. CSF not suggestive of meningitis.
Photostimulation started, phenytoin also initiated.
E,U and Cr Na= 122mmol/l (reduced), K= 2.8mmol/l (reduced), Urea=
5.4mmol/l
DAY 5 (26/6/2015)
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Child is mildly pale, afebrile(37.0oc), not dehydrated. Liver and spleen still
enlarged. Cortical blindness still present, normal pupil reaction to light, global
hypertonia. IV artesunate discontinued, oral coartem initiated. IVfluid continued
at maintenance, IV ceftriaxone continued. Biophin initiated.
DAY 8 (29/6/2015)
Was transfused on account of falling PCV (33% to 21%). This is her 7th day on
ceftriaxone. Initial cortical blindness resolving. Paucity of movement on the left
upper limb. Other limbs moving adequately.
Plan: To commence physiotherapy, discontinue ceftriaxone, discharge patient
and counsel parents.
DAY 10 (30/6/2015)
Patient discharged. To see at the clinic.

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CASE REPORT 2
DATE: 07/06/15
NAME
AGE
SEX
HOSP. NO
TRIBE
RELIGION
INFORMANT

NURUDEEN Taiye
3 years
Male
596689
Yoruba
Muslim
Mother

PRESENTING COMPLAINTS
Abdominal swelling of 2 month
Weight loss of 1 month
HISTORY OF PRESENTING COMPLAINTS
Patient was in his usual state of health until 2 months ago when mother noticed
swelling of the abdomen. Swelling was described as diffuse, hard and
progressive. No selling in other parts of the body. No history of constipation,
vomiting, diarrhea.
Weight loss started about a month ago, noticed by mother, it was rapidly
progressive evidence by the appearance of bony prominences and looseness of
previously fitting cloths.
There was history of bone pain and itching. No change in the frequency, colour
and output of urine.
Illness did not initially interfere with routine activities.
Has presented at a peripheral hospital (Child specialist hospital, center Igboro)
from where he was referred here based X-ray findings for expertise management.

PAST MEDICAL HISTORY

Previous hospital admission at three months of age on account of diarrhea and
prostration. No history of blood transfusion, surgery and he is not on any routine
chronic medication. Haemoglobin genotype couldnt be ascertained, however,
there is no history of hand and foot swelling, Haemoglobin genotype of parents
too couldnt be ascertained. He is not a known asthmatic or peptic ulcer disease
patient.
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PRENATAL, NATAL AND POST-NATAL HISTORY

Mother was regular on Antenatal Visits, booked at private Hospital, Ilorin and
not a known hypertensive, diabetic. No rash or febrile illness during pregnancy.
Pregnancy was at term (about 10 months), delivery was through a Spontaneous
Vertex Delivery at a private Hospital. Patient cried spontaneously after birth, no
history of yellowness of eyes during the first month of life.
NUTRITIONAL HISTORY
Patient was exclusively breastfed for 6 months, complementary feeds till 1 year
3 months after he was weaned into the family diet.
DEVELOPMENTAL HISTORY
He gained neck control at 3rd month of life, sat without assistance at 6 months,
stood without assistance at 9 months, was able to walk at 1 year of life.
IMMUNIZATION HISTORY
He is fully immunized for age according to the National Programme on
Immunization (NPI) schedule evidence by the award of a certificate on
completion.
FAMILY AND SOCIAL HISTORY
He is a twin. He is the second child in a monogamous family of 4 children.
Resides with parents and sibling in a Self-contain apartment. Borehole is the
water source and method of sewage disposal is through the Water closet system.
Mother is a trader with O-level while father is a Civil servant with a Diploma. He
does not sleep under Insecticide Treated Net. No history of similar illness in twin
and other first-degree relatives.
REVIEW OF OTHER SYSTEMS
Cardiovascular system: No history of Paroxysmal Nocturnal Dysnoea or
Orthopnoea, no facial or leg swelling, fainting attacks e.t.c
Respiratory system- no cough, no corrhyza, no fast breathing.

SUMMARY: I have presented a 3 years old boy who presented at the Emergency
Paediatrics Unit on account of progressive diffuse abdominal swelling with
associated weight loss, pruritus of about 2 months duration.
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GENERAL EXAMINATION
Child is a toddler who is conscious, acute-on-chronically Ill-looking, mildly pale,
anicteric, afebrile (36.7oC), not cyanosed, well hydrated, no pedal oedema.
Presence of left supraclavicular lymph node.
ANTHOPOMETRY
Weight 9 Kg (small for age)
OFC 51 cm (appropriate for age)
Length 90cm
Mid Upper Arm Circumference: 12cm at 6cm from the acromium

SYSTEMIC EXAMINATION
Abdominal system
Abdomen was grossly distended, clean and dry dressing over the Right Upper
Quadrant. Mild generalized tenderness. Multiple Intra abdominal masses.
Normoactive bowel sound
Cardiovascular system
Pulse Rate was 122 beats per minute, pulse is regular and of full volume. Blood
pressures was 100/70 mmHg. Heart sounds were S1, S2 only.
Respiratory System
Respiratory rate was 44 cycles per minute. Chest wall is symmetrical, no
scarification. Equal chest expansion, resonant percussion. Vesicular breath sound
with good air entry. No added sounds.
Central Nervous System
Child is conscious but lethargic. No signs of meningeal irritation. Pupils were
reactive to light, active movements of all limbs, anterior and posterior
frontanelles are closed. Tones and reflexes are normal.
ASSESEMENT (07/06/15)
A 3 years old child with multiple intra-abdominal masses. ? Burkitt lymphoma
Differentials: Nephroblastoma, Neuroblastoma
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PLAN
Admit patient
PCV 25%
Full blood count plus differentials, genotype, blood culture, urinalysis,E U & Cr
RDT for malaria - negative
RBS 4.3 mmol/l
IVF 4.3% dextrose saline = D10 in 1250 mls over 24 hours
Ultrasound guided Biopsy for histology
Ultrasound scan
Monitor vital signs
Apply penile conduit and monitor urine output.
Counsel and inform mother about childs condition.
FOLLOW UP
DAY 3 (09/06/15)
3 years old boy with multiple intra-abdominal masses ?Burkitt lymphoma.
Histology result shows small round blue cell. No new complaint.
TPR chart was normal
O/E Child is a toddler who is conscious, acute-on-chronically Ill-looking, mildly
pale, anicteric, afebrile (36.7oC), not cyanosed, well hydrated, no pedal oedema.
Presence of left supraclavicular lymph node.
Assessment: Burkitt lymphoma
Plan:
IVF 4.3% dextrose saline = D10 in 1250 mls over 24 hours
Tab Allopurinol 100mg b.d
IM Pentazocin 10mg 8 hrly
Allow oral intake if tolerated
Tab Captopril 12.5mg b.d
Monitor Blood Pressure and other vitals
IV Cefuroximme 375mg 12 hrly

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DAY 7 (13/6/15)
Continue previous management
Give IV Ondasetron 2mg stat
Commence IVF hyperhydration at 3 litres/m2/day
Commence cytotoxics (Cyclophosphamide, Vincristine and Methotrexate)
DAY 10 (16/06/15)
Continue previous management
Discontinue Pentazocine
IVF 4.3% D/S at 2 litres/day
Patient developed multiple mouth ulcers after chemotherapy
DAY 11 (17/06/15)
Continue Antibiotics
Continue Allopurinol
Continue Captopril
Complete 10 days of Cefuroxime
Transfer to ward
DAY 13 (19/06/15)
Child was said to be passing loose stool and had 6 episodes in the last 24 hours
Continue IV fluid at 2 litres/day at 28 drops per minute
Continue Allopurionol
Complete 10 days of Cefuroxime (indicated because child had mucositis after
chemotherapy)
DAY 14 (20/06/15)
Discontinue IV fluid
Liberal oral fluid intake
Discontinue Cefuroxime
Monitor vital signs
DAY 15 (21/06/15)
Update, FBC, Blood culture, ESR
PCV- 26%
Vital signs: BP-120/70 mmHg, HR-128 beats per minute

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Commence Tab Septrin tds 2 daily

IV cefuroxime 500mg 12 hrly
Monitor vital signs

DAY 17 (23/06/15)
Child has mucositis and tongue ulcerations which have worsened. There was
facial puffiness. TPR showed Intermittent fever
IV fluid 4.3% D/S at 1250 ml dly
Discontinue Septrin
Continue Captopril, Cefuroxime
DAY 24 (30/06/15)
Hb-10g/dl, MCHC-30g/dl, PCV-32%, RBC-4.08x106/microliter, WBC-2.5x103/
microliter, MCV-78fl, MCH-24pg, Platelet-126x103/microliter, neutrophil-35%,
Lymphocyte-60%, others-5%
DAY 25 (01/07/15)
Continue Cephalexin
Continue hyperhydration
Discharge home, 2nd course of chemotherapy scheduled for 06/07/15

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CASE REPORT 3
DATE: 12/06/15
NAME:
AGE:
SEX:
HOSPITAL NUMBER:
ADDRESS:
TRIBE:
RELIGION:
INFORMANT:

ASHRAFF Muhammed
23 months
Male
381001
Sango, Ilorin
Nupe
Muslim
Mother

PRESENTING COMPLAINTS
Refusal of feed of 2 days duration
Fever of 2 day duration
Vomiting of 1 day duration
HISTORY OF PRESENTING COMPLAINTS
Patient was in his usual state of health until 2 days prior to presentation when
the child started refusing feeds with associated passage of loose stool. Passage
of loose stool started few hours prior to presentation and experienced about 12
episodes, stool was brownish in colour, mucoid but non-bloody, each bout was
about 120mls. However, patient was on haematinics prescribed at a peripheral
center.
Fever started the same day as the refusal of feeds, fever was of sudden onset,
high, continuous relieved transiently by Paracetamol and tepid sponging. There
was no associated convulsion, no discharge from any craniofacial orifices.
Vomiting started few hours to presentation. It started at night, patient had 6
episodes of projectile, non-billous vomiting and contains recently ingested
drugs and feeds. Vomitus does not contain blood.
Prior to presentation at the Emergency Paediatric Unit, Patient had presented at
a private hospital where he was given antibiotics, antimalarial, Oral Rehydration
Salt and Paracetamol. His condion however did not improve to mothers
expectation warranting a self-referral here.

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PAST MEDICAL HISTORY

He is a known HbSS patient diagnosed at GOPD at 1 year of age, patient does
not attend any sickle cell clinic. No history of blood transfusion or surgery.
However, patient has been admitted before on account of fever 4 months ago at
Olaoluwa hospital and was given folic acid, palodrine and Paracetamol. There
was history of yellowness of the eyes.
PRENATAL, NATAL AND POST NATAL HISTORY
Patient is the first child of the mother. Mother was booked for antenatal at a
private hospital and period of pregnancy was not adversely eventful. Child is a
product of term pregnancy, delivered via spontaneous vertex delivery at a
private hospital. No history of prolonged labour. Child cried immediately after
birth. No history of neonatal jaundice and no cause for prolonged hospital stay.

NUTRITIONAL HISTORY
Child was exclusively breastfed for about six months before complimentary
feeds was commenced. Child is currently on the familys diet.

IMMUNIZATION HISTORY
Child has been completely immunized according to the National programme on
immunization schedule.

DEVELOPMENTAL HISTORY
Gross motor, fine motor and speech development has been progressive and not
adversely eventful. Child gained head control at two months, sit at five months
and stand without support at twelve months. Child is ambulatory.
FAMILY AND SOCIAL HISTORY
Patient is the second child in a monogamous family with two children, resides
with his parent in a flat apartment. Uses mosquito treated net. Mother has a
Bachelor-in-Science degree and works at the state ministry while the father has

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Higher National Diploma and is a businessman. Haemoglobin genotype of

parents is AS.
REVIEW OF OTHER SYSTEMS
Respiratory System - no dyspnea, no breathlessness, no cough
Cardiovascular System no cough, no orthopnea, no paroxysmal nocturnal
dyspnea
Urinogenital System no frequency, no dysuria, however, there was reduction
in urine output, passage of Coca-cola coloured urine
SUMMARY
I have presented Ashraff Muhammed, a 23 months old who was here on account
of two days history of refusal of feeds, fever, passage of loose stool and
vomiting of a day duration.
GENERAL EXAMINATION
On examination, child is conscious and irritable, mildly dehydrated, mildly pale,
not icteric, acyanosed, not in any obvious respiratory distress, febrile (38.3oC),
no significant peripheral lymph node enlargement, no digital clubbing, no pedal
edema.

ANTHROPOMETRY
Weight 9Kg (appropriate for age)
OFC 47 cm (appropriate for age)
Length 80cm
Mid Upper Arm Circumference: 16cm at 6cm from the acromium

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SYSTEMIC EXAMINATION
Central nervous system
Child is conscious and irritable. Neck is supple, no signs of meningeal irritation.
Pupils were reactive to light, active movements of all limbs, anterior and
posterior frontanelles are closed. Tones and reflexes are normal.
Cardiovascular System
Pulse rate is 110 beats per minute. No precordial hyperactivity, apex beat at the
fourth left intercostal space mid clavicular line. First and second heart sounds
only were heard. Blood Pressure is 80/50 mmHg
Respiratory System
Respiratory rate is 17 breaths per minute. Chest wall is symmetrical, no
scarification. Equal chest expansion, resonant percussion. Vesicular breath
sound with good air entry. No added sounds.
Abdominal
Abdomen is full, moves with respiration, no scar or scarifications. Soft with no
area of tenderness, liver is 4cm below the Right Costal Margin, it is smooth,
non-tender and soft. Spleen are not enlarged and the kidneys are not ballotable.
Percussion note tympanitic, bowel sound normoactive.

ASSESEMENT
23 months old known HbSS with Sepsis with evidence of mild dehydration
(5%)
PLAN
Admit patient
PCV 25%
Full blood count plus differentials, genotype, blood culture, urinalysis,E U & Cr
RDT for malaria - negative

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RBS 6.3 mmol/l

IV cefuroxime at 150mg/kg/day in 2 divided doses
IM Genticin at 5mg/kg/day in 2divided doses
IVF 4.3% destrose saline at maintenace
Monitor vital signs
Apply penile conduit and monitor urine output.
Counsel and inform mother about childs condition.

FOLLOW UP
DAY2 (13/06/15)
23 months old known HbSS boy being managed as a case of Sepsis with mild
dehydration. Stool colour is normal and volume of urine output has increased.
No new complaint.
TPR chart was normal
O/E child is conscious and alert, afebrile, not pale, anicteric, not dehydrated,
acyanosed, not in any obvious respiratory distress, no peripheral
lymphadenopathy, no pedal edema, no finger clubbing.
Assessment: Resolving sepsis, resolved dehydration
Plan: Continue present management
DAY 3 (14/06/15)
23 months old known HbSS boy being managed as a case of resolving Sepsis.
No new complaint.
TPR chart was normal
O/E child is conscious and alert, afebrile, not pale, anicteric, not dehydrated,
acyanosed, not in any obvious respiratory distress, no peripheral
lymphadenopathy, no pedal edema, no finger clubbing.
Assessment: Resolving sepsis
Plan: remove penile conduit
Change parenteral antibiotics to oral
Fluid intake orally
Counsel mother on need to present child regularly at the sickle cell clinic
Discharge to clinic
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