این کیس مربوط به تاریخ 1395/12/4  میباشد

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به نام خدا

A 16 mon age boy came with 1 wk fever ,  post intranasal Sx brief serosangoinous discharge , nasal  stiffness , enlarge painful RT cervical  L.N and RT ear purulent discharge.G1 P1 Ab0 L1

Parents are non relative  No Hx of mortality&immundeffiency& allergy ,other disease in his family. Umbilical stump fall of at 7^th day of born.

Past  Med Hx:

Several Hospital admission period,  the first at 16 days old  age(sepsis) ,the others UTI, pre maleolar abscess formation,  and the pre  last admission was for nasal polyp resection.

     94.10.10 - 94.10.28 Patient was  admitted for cervical L.A.P  and lymph    adenitis  

cervical Sono graphy: Multiple enlarge  L.Ns  up to 14mm . the two are abscess form.( Supportive lymphadenitis)

Abd  sono : NL

Cervical  CT: Cervical multiple  enlarged  L.Ns .

  Patient was Discharged  with Co-Amoxy clav.

After discharge:Nasal stiffness  and  Rt nasal mass  bioppsy at  94.11.28

Pathology:    sever acute and chronic inflammation ,fibrino Leukocytic  exudate and   granulation tissue formation

94.12.2  Brain  MRI:NL

Para nasal  sinus MRI : Soft tissue lesion(polyp?) 17x9x7mm on Rt nasal fossa       94.12.17- 94.12.18.Hosp admission   cc: nasal stiffness& mass

Rt nasal mass Excision  BX Patholgy :  mixed lympho histocytic and PMN infiltration not excluding HISTOCYTOSIS

95.1.26- 95.2.13  admitted for Abscess on previous site of IV line( Lt.medial.maleulus)   treatment was started.  MRI of Lt leg; localize inflammatory prossess and cellulitis

CBC-diff: WBC=16200      Neut=62%       Lymph=34%       mix:4%

 Hgb=9.1 Palt=669000      ESR=42    C3-C4:NL    HIV :Neg          NBT>90   

Pt  was discharged with cyprofluxacin and   refered to Rheumatologist. 

 Because nasal stiffness &bleeding had been continued  Pt  return to physician

95.3.4      CBC-diff: WBC=24220      Neut=38.1%       Lymph=47.7%

EOS:10.4%  Momno:8.7%    Hgb=9.5g/dl  RBC=4.6    MCV=65.4     Palt=616000    

 ESR=42    CRP=100      SGOT:31   SGPT: 13      U/A:Nl   U/C:No Growth

 RF:Neg   Tuberculin Test:15mm    IgG:1518 mg/dl   IgM:168   IgA:9 IgE:38.2

 95.3.25    NBT test :94% 

95.4.6:  Bone Survay:NL

 Anti Diphteria Ab :0.16     Anti Tetanus Ab:0.4

Flocytometry:

Lymphoid marker     Lymph% 

CD 3                              55

CD 4                              35

CD 8                              18

CD 19                            43

CD 20                            43

CD 16                             2

CD 56                             2

سی تی اسکن اسپیرال گوش داخلی(دردوجهت کرونال واگزیال بدون تزریق):

Petrus bone : nl

Lt canal have  nl margin and diameter in both side .

Bi lat cochlea ,vestibular,semicircular canals :nl

Mastoid ear cavity& middle ear ossicles :nl

No lesion in external auditary canal

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