Rathee Hospital

17/02/2024

I would like to share a simple but very interesting case. 3 yrs old female child resident of Indore, relative of a Paediatrician came to my Rathee hospital with complaint of fever for 11 days, neck stiffness for 3 days from D2 of fever. Child was shown to Paediatrician in Indore where child was given Amoxyclav and zifi in these 11 days. But fever persisted in child.

Child presented to me with complaint of persistence of fever only. Child was playful and physical examination normal. All investigation came normal except raised CRP and TLC but normal neutrophil. Parents complaint of slight behaviour change in child, slight irritable and decrease oral intake.

PROCALCITONIN came negative, CSF examination normal and blood culture shows no growth. USG neck and abdomen normal except matted and necrotic cervical and supraclavicular lymphadenopathy. Now it' s D18 of high grade fever upto 103-104 degree Fahrenheit. Earlier patient was started on piptaz for 2 days and now it' s D6 of meropenem and linezolide. Lymph node FNAC - inconclusive so supraclavicular lymph node excisional biopsy was done- 3 matted lymph node were excised and sent to 3 different lab. BLOCK TEST- gene expert (lal path lab) and histocyto was sent. Except reactive lymph node nothing came positive.

Now fever intensity and frequency decreases and is slightly down to 101 degree Fahrenheit. Repeat PROCALCITONIN again came negative. Till now total 3 blood culture came negative. Weil Felix test came positive so we stop injectables and started doxycycline. But fever intensity increased again to 103. We sent confirmation test for scrub typhus (IgM and IgG Elisa) which came negative.
Now it's nearly 20 days of high grade fever and no physical finding except lymphadenopathy in cervical area. Now b/l submandibular LN appears which were tender. We already did USG neck but to rule out deep seated foci we did CT scan of Neck and thorax.

Atlast we got focus- b/l submandibular collection of pus extending to retropharyngeal, more on left side. We did USG guided aspiration and sent pus culture which grew STAPH.
Dx Retropharyngeal abscess

06/02/2024

Wanted to share a very interesting case with all of you.

A 2 1/2-year-old child raised as a girl was referred to Dr Vaishakhi Rustagi for DSD.

She had an external genitalia of a female and was declared a female and raised as a female, until no vaginal opening was noticed by the parents.
A local Doctor had
tried to make a vaginal opening by a scalpel in the perennial area without any anaesthesia in their village. Since no vaginal pathway was formed, they came to the city and reached out to many doctors for help.
Disheartened, financially and mentally exhausted. they finally met Dr Vaishakhi for abnormal Genetelia.

After doing all the biochemical test and the Karyotype the child had 46 XY and Was diagnosed to have 5 Alpha reductase deficiency.

Hence , after prolong , detail discussion and counseling of family they reached to a conclusion- raising this child as a BOY.

Since there was no pe**le structure and the child had a Penoscrotal hypospadias, we now had to work on his external genitalia.
He was operated for bilateral undescended Te**es and peno scrotal hyposposias repair at Rathee hospital rohini.

We worked hard as a team and took care of - endocrine and Surgical part.

As this required a multidisciplinary approach , we managed this complex disorder as a team with the help of dedicated paediatric intensivists ,endocrinologists, pediatric surgeon nd anaesthetist at our centre.

This patient had a successful outcome and is the 4 th such case that we managed at our centre.

16/08/2023

Patient came to OPD with no pulse and saturation. Now discharged with smile on her face.

25/11/2020

25/11/2020

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25/01/2019

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16/01/2019

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21/12/2018

05/11/2018

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27/10/2018

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