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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes cough and wheezing in a toddler?

Over the course of 6 days a toddler, 2yo black female ran fever, vomiting, coughing, wheezing, not eating and minimal drinking was seen by ER twice and pediatrician twice, all diagnosed virus mimicking flu like symptoms. Child uses an inhaler as needed and takes Zyrtec daily, and is allergic to bananas, eggs and tree nuts. Child was given Zofran for vomiting. Day 6, third ER visit, no change in child’s condition and breathing seemed difficult, this time x-ray was ordered and showed child had pneumonia. Right lung filled with fluid and child admitted to local children's hospital. Upon admittance, day 7, it was determined that white cell count was very high and intervention was necessary. Surgery to insert a chest tube was order within a couple of hours. A camera was used to identify a mass or obstruction. Mother was told the mass was a ball of mucus that they removed and inserted chest tube to drain. Child recovered in ICU with continuous fever and moved to respiratory floor with oxygen and albuterol. Child is still not eating only drinking small amounts, on IV fluids, antibiotics and morphine for pain. Fever continues after surgery day 8, through day 13, and was being managed by Motrin and Lortab for pain. On day 13 it was noticed that the child had develops bad rash between buttons and was given ointment but child screamed at every attempt to change diaper. Child did not respond to pain to touch legs or abdomen but does cry out when lifted or moved. Child can walk but seem unsteady which was attributed to the pain medication. Day 13 child was seen by infectious disease team because white cell count was higher that when the child was admitted and now showing anemia. After review with infectious disease team regarding events of the past week and family history, child was discharged with 7 days Lortab, 14 days amoxicillin, iron drops and ointment for rash and continue daily Zyrtec and inhaler as needed. Child still does not have an appetite, drinking only juice, apple and grape. Day 16 follow up appointment with pediatrician. No real change in her from discharge to doctor’s visit. No fever at the time of visit but Dr. had blood drown to check white cell count against previous labs. Day 17 child will take a few bites of food like yogurt and pears here and there but no full meal. Child still moans when resting and/or sleeping and continues to cry out when coughing as if she is in pain. Fever still comes and goes. Rash cleared up but child still cries out and flinches whenever someone attempts to move her to change the diaper or lift her butt. Fever continued to come and go through day 19. Continue to check and change dressing on surgery area where chest tube was removed. Site appears to be healing and child does not flinch when touched and does not seem tender in that area. Day 20, noticed child’s palms appear to be very pale, no sign of blood flow or resting in her palms. Child walks and still very unsteady and has to hold onto objects or hold someone’s hand to keep from falling or losing her balance. On day 20 and 21, first day and a half without any fever, but child is still not eating and coughing up mucus. She shows signs of being her normal self but quick falls back into not feeling well when coughing or being moved or picked up. Mother contacted the pediatrician about concerns with walking and no color in her palms. From what I have been researching based on all the symptoms, should we have the toddler tested for HLH or is that a stretch from internet panic?
Wed, 3 May 2017
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Ayurveda Specialist 's  Response
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Thanks for contacting with your health concern and after reviewing your case history I'm of the following opinion:

1. Since she has been seen by a Pediatrician and Infectious Disease Specialist team thus they must have given due consideration in taking up her case and closely following the investigations and examination so remain under constant supervision and observation of them.

2. Internet is just for guideline and in no way a substitute for Doctor so under no circumstances you should rely on HLH [hemophagocytic lymphohistiocytosis] since it will require necessary investigation [complete blood count, bone marrow biopsy, hematologist Opinion] and only then one can conclude the same, because one has to first other common possible causes like tuberculosis, malaria,asthma,heart disease.

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