CASE HISTORY NAME: Gaida a Hakam Al-Hitari AGE: 5 years old GENDER: Female DATE: 18-3-2010 Chief Complaints: fever, abdominal pain, and lower extremities BONE pain ( femur-tibia) for 2 days. H.P.I: Patient female of 5 years old with history of RECURRENT infection (most commonly tonsillitis) in range of one time infection per month for the last 3 years, brought recently with fever and bone pain for 2 days which preceded by abdominal pain for one day. Patient s mother said that This complaints came after 3 days of completion of antibiotic course (cifixime) which was prescribed for her before one week for tonsillitis. Past And Birth History : ·     Normal Trans-Vaginal Birth With Weight Of 3.75 Kg At Home. ·     Normal Breast feeding in the first 2 weeks but diarrhea was from the second day of birth which started to be associated with crying after breast feeding after 2 weeks of birth and this complaints continue until the age of 4 month as on and off associated with severe loss of weight and stopped for 2 months and appears again specially with each tooth appearance till the age of 2.5 years old. ·     After the age of 2.5 years old diarrhea stoped but the complaints of fever, abdominal pain and bone pain still. Family history : father had T.B on child hood and treated and his mother (patient s grandmother) had also T.B at same period and treated also, but recurrent infection was appear before one year from now and also treated with close contact with the patient. Drug history: ·     patient manly use the following drugs in the last 2 years :full courses of antibiotics {Oraluxe (Cefpodoxime) Roceflex (ceftriaxone), Cifixime, Penicillin Syrp, Lincomycine.Inj Retarpan.Inj(every 21 days) for 6 months }for each period of infection. ·     A course of 2 weeks period of Prednisillone was given started in May 2009 and give benefit for the patient for a period of 6 months without any infection but recurrence was happen after that. Social history: good in all aspectsâ?¦ Physical examinations: General examination : Patient Conscious, Alert, Looks Tired, paler, Anemic, thin body built, malnourished and Not Jaundiced . Anthropometric Measeurments: Weight: 11.9 kg. Height :102cm. Head circumference: 46cm. Mid Arm Circumference: 12cm. Vital signs: Body temperature:39.9 C. Respiratory R.: 30 cycle Regional examination: Head :Normal Color Hear And Normal Distributionâ??normal eye brows distribution- long eye lashes , runny nose , mouth: no ulcerations or gum hypertrophy, no hyperemic or pus on tonsils or pharyngs. Neck: no lymph node enlargement or swellings, Chest : normal bilateral air entry, with rhonchi, Heart : s1-s2 heard , systolic murmur grade II . palpation and percussion no significant abnormalities. Abdomen : soft, slightly tender, no palpable organomegally Extremities: normal skin tincture, no ulcerations or palpable dorsalis pedis pulse.. LAB TESTS: 27-5-2010     13-3-2010     10-5-2009     1-4-2008            12     11.2     11.2     11,4     HB      18.1     9.4     10.2     12     W.B.C      71     27     35     47     NEUTROPHILE      9     65     60     41     LMPHOCYTE      02     06     02     02     MONOCYTE      Band 18     0 0     ESINO 3 baso 0     BAND 10           NORMAL     550     NORMAL     NORMAL     PLT,S      N     N     N     NORMAL     MCV,MCH,PCV,PIB           NORMOCYTIC NORMOCHROMIC          NORMOCYTIC NORMOCHROMIC     RBC      ABSOLUTE NEUTROPHILIA AND SHIFT TO THE LEFT     ABSOLUTE LEUCOCYTOSIS WITH REACTIVE LYMPHOCYTE ++-THROMBOCYTOSIS          ABSOLUTE LEUCOCYTOSIS     WBC                                100     80     70      87     ESR            NORMAL     400     NORMAL     A.S.O           PO SITSVE     PO SITSVE          C.R.P           NORMAL     NORMAL          R.F                NEGATIVE          TUBERCULIN DOUBLE STRETH           NORMAL               WIDAL TEST                                     NEGATIVe(11-5-2009)     PO SITSVE 1/8          brucella abortus            NEGATIVe(11-5-2009     PO SITSVE 1/80          brucella melitensis           PO SITSVE               ANA                          HB ELECTOPHORSIS           NORMAL               C3,C4,           NORMAL               IgG,IgA.IgM      PO SITSVE(80.)                    ANTI DS.DNA      Now my dauter is very sick ,here fever 40 ,do i make a bone marrow examination....