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hepato-splenomegale /


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We have a 1 month male baby, who has been referred for hepato-splenomegale, and peritoneal lymphadenopathy , confirmed by ultrasound abdomen , no other significant history , no fever no other signs of sepsis.

Anti-natal history of mother getting on and off fever from gestation of 5 months,

Mother u/s ab : omental thickening, ? TB

Baby on DBF

We suspected sepsis, lymphomas , infiltrative disorder , congenital tuberculosis .

Sepsis screening - negative , baby is not sick

TB; gastric aspirate, PCR for TB is negative

LFT-normal, PT ptt : Normal

Immunoglobulin levels -normal

VDRL, HIV, NEgative

Hb: 9.5, TC : 9000, platelets : 1.2L

Bone marrow - ? Normal study

Please give your opinion , what to do further ,

THANKYOU

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suspected congenital tuberculosis is a tough one; is the mother on TB treatment?

a) What did the baby's CXR reveal (although congenital TB can present with no CXR findings initially, it will still be worth checking)

B) mantoux interpretation and TB interferon gamma assay (TB Elispot) aalso difficult to interpret in endemic environment and considering age; nevertheless a positive result would indicate infection at least and with symptomatology you would be obliged to treat as Tb disease

In my experience, with suspected maternal TB in an endemic setting for TB, and a baby symptomatic for a chronic infection, we have offered a course of TB treatment.

Will also be worth checking CMV status

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