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پروفسور محمد حسین سلطان زاده
استاد
دانشگاه علوم پزشکی شهید بهشتی
متخصص کودکان ونوزادان
طی دوره بالینی عفونی از میوکلینیک آمریکا
دبیر برگزاری کنفرانس های ماهیانه گروه اطفال
دانشگاه علوم پزشکی شهید بهشتی
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دکتر نقی دارا
فوق تخصص گوارش کودکان
به اتفاق اعضای هیئت علمی بخش کودکان بیمارستان
مفید
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معرفي بيمار
The patient is a 6
years age old who presented with epistaxis, anorexia, weight loss about 10 kg
from 3 years ago. During this course his mother compliant of weakness, inability
to make attention, connection and behavioral change. The patient was brought to
this center due to liver enzyme elevation.
He had not any other
history such as seizure episode, jaundice, nausea, vomiting and fever.
Drug Hx: He had not
any significant drug history or herbal medicine may affect liver enzyme.
FMH: No significant
P/E:
BWt: 4200gr
admission weight: 21 kg PR: 72/ min RR: 18/min
Skull: normal
N/E: Gait:
normal DTR: 2/2 MP: 4/4 speech:
Attention:
weak
Heart: Normal s1s2
Chest and lung: normal
breathing sound
Abdomen: soft without
organomegaly
Extremities: normal muscle bulk, MP: 4/4
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WBC |
5700 |
6800 |
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10900 |
Vit D25OH |
98 ng/ml |
41 ng/mL |
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Hb |
11.9 |
11.9 |
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11.9 |
Ferritin |
125 ng/ml |
75 ng/mL |
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MCV |
78 |
80.9 |
|
77 |
T3 |
2.2 |
2.18 nmol/L |
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MCH |
23 |
26 |
|
26.5 |
T4 |
9.5 |
86.82 nmol/L |
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Plt |
352000 |
336000 |
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376000 |
TSH |
1.65 |
2.67 |
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PMN |
29% |
28% |
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29% |
ANA |
1/80 |
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Lymp |
64% |
62% |
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61% |
ASMA |
1/80 |
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ESR |
13 |
12 |
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AMA |
Negative |
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TP |
|
7.4 |
7 |
7.2 |
ALKM1 |
Negative |
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Alb |
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4.8 |
4.6 |
4.5 |
Ceruloplasmin |
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4 mg/dl |
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AST |
475 |
421 |
430 |
340 |
Urine 24 copper |
103 Mcg/24h |
100 Mcg/24h |
107 |
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ALT |
345 |
422 |
485 |
290 |
HBS-Ag |
Negative |
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TB |
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1.02 |
0.6 |
0.2 |
HBC-Ab |
Negative |
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DB |
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0.10 |
0.2 |
0.1 |
HCV-Ab |
Negative |
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Alkp |
|
1116 |
367 |
900 |
HIV |
Negative |
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Glb |
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2.6 |
2.4 |
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TTG-IgA |
2 |
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PT |
12.5 |
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14 |
EMA-IgA |
Negative |
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INR |
1 |
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1.3 |
IgA |
125mg/dl |
96 mg/dl |
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PTT |
39 |
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34 |
HBS- Ab |
<3 IU/L |
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GGT |
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54 |
72 |
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Ca |
9.3 |
9.8 |
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CPK |
5077 |
2613 |
1920 |
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Ph |
4.5 |
5.1 |
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LDH |
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605 |
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Na |
140 |
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TG |
88 |
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96 |
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K |
5 |
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Choles |
189 |
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178 |
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AFP |
9.2 IU/mL |
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Uric acid |
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3.2 |
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U/A |
Normal |
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BS |
83 |
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S/E |
Normal |
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BUN |
13 |
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Crea |
0.66 |
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Echocardiography:
normal with Good LV function, Ejection fraction = 60%
Abdominal
ultrasonography: Size and parenchymal echogenisity of liver are normal. Gall
bladder and pancreas are normal. Spleen was normal.
What is your
diagnosis?
What are differential
diagnosis?
What is your
confirmation test?
Best Regard
Dr. Naghi Dara
Assistant professor of
Pediatric
gastroenterohepatologist
تشخيص شما چيست؟
