Dr. Sridhar B. writes:

This 3.5yr old male child was referred from alangulam.
He presented with c/o fever,vomiting, altered sensorium and seizures -1 day duration.

Suspected as meningoencephalitis.No H/o significant past illness.

At the time of presentation child was semicomatose,dehydrated and was in shock.In GPE, he was very much hyperpigmented.His tongue was also hyperpigmented.

Based on the clinical picture, we suspected Addison Disease.

Blood sugar was checked which was 36mgm/dl.IV cannula was put and blood samples were collected for investigations.10%dextrose boluses were given to correct hypoglycemia.Fluid resuscitation was done with normal saline.In view of Addison Disease, bolus of hydrocortisone was given.

With above measures child had remarkable improvement within six hours.meanwhile his electrolytes reports were Na-120,k-5.6,cl-90. After stabilisation, Endocrinologist opinion was sought. Child’s ACTH was remarkably elevated. So his Addison Disease -primary hypoadrenalism was confirmed.

He was put on oral hydrocortisone and fludrocortisone. At present child is doing very well and he is regularly coming for the follow-up.what we insist to the parents were -life long steroid replacement therapy, early attention to fluid losses.This case is being presented here for its classic presentation. High index of suspicion is necessary for the diagnosis.

19/7/2016] Sridhar B. Dr: This is the case history,symptoms and management discussion by our Rajapalayam IMA member DR JEYARAMAN PAEDIATRICIAN. ,,,, pres.IMA Rajapalayam-Dr kothandaraman