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Child has consistent low grade fever causing weight loss, low appetite. Labs show high WBC count. Reason?

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7 yr old with low grade fever for 2 months, refusal to eat, lost 8 lbs, blood work all normal, except a little elevated white cell count, neg for celiac disease.
Posted Thu, 6 Jun 2013 in Child Health
Answered by Dr. Taher Kagalwala 32 minutes later

Thank you for choosing XXXXXXX to address your query.

The history that you have provided is extremely threadbare, and I need several more details:

Is the child a male or a female (it is relevant, believe me)?
(I am assuming this is a male, hence I will henceforth address your 7 yr old as "he".)
Was he a normal delivery?
Is he born of a cousin marriage? If yes, have any members from both families had a similar course of events such as he is experiencing?
What was his first year like? Has his health been TOTALLY normal (barring sore throats etc, especially if they have not been too frequent)?
Has he had frequent or unusual infections through his first six-seven years of life to the present?
Is there large, offensive smelling stools?
Does he have or has he had symptoms of urine infection, chronic lung infection or recurrent diarrhoea (loose motions) or middle-ear or sinus infections? All these may point to a specific immune deficiency disorder.

The history may have suggested coeliac disease, but one needs to rule out cystic fibrosis as well as immunodeficiency disorders of the kind that affect neutrophils or their function, antibodies or their function, or/and others that cause failure to thrive. The low grade fever could either be due to the primary disease or be secondary to one of the infections that occur easily in immune deficient children.

Could all this be just an exaggerated thinking and could all that I have said be an overestimation of his illness? Certainly, yes. It might happen that he has no serious immune problems. In such an event, you would probably end up spending more money, but you would be reassured in the end that you did not miss anything serious in the child.

I know my answer seems overwhelming to a lay person like you, but he will definitely need a detailed look to rule out a defect in his immune system.

Kindly revert to me with the answers to the above queries. Also, if possible, scan his reports of full blood counts and other investigations and X -rays if any, and send them across to me.

Awaiting your early feedback,

I am,

Yours sincerely,

Dr. Taher
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