HIV in Children
Mediastinal adenopathy
Ira Shah
Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital, Mumbai, India
Incharge, Pediatric HIV and TB Clinic, B J Wadia Hospital for Children, Mumbai, India

A 7 years old HIV infected girl presented with fever for 3 months and dry cough for 2 months. She was on regular TMP-SMX prophylaxis and was lost to follow up for past 4 years as parents found her to be asymptomatic. She had tuberculosis at 11 months of age and had taken antituberculous therapy (ATT) for 6 months for the same. On examination, she had generalized insignificant lymphadenopathy and systemic examination was normal.
Investigations showed:
• Hemoglobin = 12 gm/dl, WBC count = 8,900/cumm [45% polymorphs, 55% lymphocytes], ESR = 112 mm at end of 1 hour.
• Chest X-Ray = Superior mediastinal widening with parahilar lymphadenopathy.
• Mantoux test = Positive (10 x 10 mm)

The child was suspected to have mediastinal adenopathy that was compressing the airway and leading to dry a cough. Fever could be due to the adenopathy. The child is suspected to have mediastinal adenopathy due to tuberculosis. However, lymph node biopsy is not possible as parents are not willing for a biopsy.

How to confirm the diagnosis of TB in this child?
See Previous Teaching Files
Pediatric Oncall Book Store
Infection in Children - Part 2

By Dr. Ira Shah
Case Rounds in Pediatric Liver Disorders
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Management of Pediatric HIV
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Infection in Children
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