A 5 year old boy of African descent was brought to the clinic because his eyes t
ID: 85820 • Letter: A
Question
A 5 year old boy of African descent was brought to the clinic because his eyes turned yellow after taking a tablet of anti-malarial drug: primaquine for malarial prophylaxis because he will travel to a malaria-endemic country next week with his parents. His urine also turns darker in color. He did no experience any fever, abdominal pain, nausea, vomiting. This is the first time he had this condition, and he had completed his basic immunization with his pediatrician.
Physical exam:
Temperature: 37o Celsius (normal: 36.10-37.20)Blood pressure: 110/80 mmHg (normal: 120/80 mmHg)heart rate: 95 beat/minute (normal 60-100 x/minute)respiratory rate: 16/minute (normal 12 – 20 x/minute)Normal weight boy, yellow-appearing, normal developmental milestone. Looks alert, have normal eye-contact.Skin and sclera of the eyes appear yellow, conjunctivae look anemic.Heart: heart sound normal, no heart enlargement, no murmurLung: clear to auscultation.Liver and spleen: no enlargement.
Other physical examination is normal for his age.
1) what are the possible diagnoses(differential diagnoses) give 3
2) explanation of pathology of each of the differential diagnoses
3) suggestion of what extra work up/laboratory/diagnoses test/information needed to come to a more definite diagnosis for this patient
Explanation / Answer
1.
The patient may be affected with glucose–6–phosphate dehydrogenase deficiency or jaundice or Splenomegaly.
2.
If the patient has a hereditary enzyme deficiency of glucose–6–phosphate dehydrogenase (G6PD) then that cause hemolysis when treated with oxidant drug like primaquine. In case of haemolysis the eye turns yellow and the urine is dark coloured.
Sometimes treatment with primaquine results in hemolytic anemia which ultimately leads to jaundice and choluria. Both of these may cause the yellow eye and dark colured urine.
Splenomegaly may also responsible for this condition. Higher rate of hemolysis results into enlargement of the spleen. In this condition haemoglobin level may drop. Urine becomes darker.
3.
Patient must be check for glucose–6–phosphate dehydrogenase enzyme, bilirubin level in blood, SGPT/SGOT level in blood, level of haemolytic products in urea. A whole abdominal UCG test will be good to provide information regarding size of liver and spleen.
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