Diagnostic Tests for Bullous Pemphigoid
Bullous Pemphigoid Tests: Book Excerpts
Bullous Pemphigoid Diagnosis: Book Excerpts
Diagnostic Tests for Bullous Pemphigoid: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Bullous Pemphigoid.
Vesicular and Bullous Eruptions:
Testing
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. The Tzanck smear is used to diagnose viral dermatoses: herpes simplex, herpes zoster, KVE, and varicella. Select an early intact vesicle without infection or trauma; remove the blister top and scrape the floor lightly with a scalpel; smear the material on a clean glass slide; air dry and fix; stain with Wright or Giemsa stain. A positive test is the presence of multinucleated giant cells (2).
B. Biopsy of the edge of the blister and subsequent immunofluorescent staining is helpful for diagnosing pemphigus vulgaris, bullous pemphigoid, and EMB (3).
Diagnostic assessment
The presence or absence of a toxic appearance guides the clinician initially. History that includes age, season of onset, special precipitators, whether the lesions are itchy, and the duration of lesions then further assists in classification. Finally, the appearance of the lesions and their distribution further reduce candidate illnesses. It is important to remember that significant and occasionally life-threatening illnesses present as vesiculobullous lesions.
References
1. Robin KL, Piette WW. Cutaneous manifestations of systemic diseases. Med Clin North Am 1998;82(6):1359–1379, vi–vii.
2. Brodell RT, Helms SE, Devine M. Office dermatologic testing: the Tzanck preparation. Am Fam Physician 1991;44(3):857–860.
3. Gellis SE. Bullous diseases of childhood. Dermatol Clin 1986;4(1):89–98.
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Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Cough - Case 4-2: 7-Week-Old Boy:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 37.3°C; RR, 54/min; HR, 153 bpm; BP in right upper extremity, 93/59 mm Hg; BP in left
upper extremity, 87/62 mm Hg; BP in right lower extremity, 94/63 mm Hg; SpO
2, 95% in room air
Weight, 4.5 kg
Initial examination revealed a well-developed infant in moderate respiratory
distress. The physical examination was remarkable for nasal flaring,
intercostal retractions, and intermittent grunting. He had good aeration and
scattered rales at both lung bases. Cardiac examination revealed a normal first
heart sound (S
1) and a prominent second pulmonary sound (P2). A II-III/VI systolic murmur was appreciated at the left sternal border. The
liver edge was palpated 4 cm below the right costal margin. The remainder of
the physical examination was normal.
IV. Diagnostic Studies
Laboratory analysis revealed a peripheral blood count of 8,400 WBCs/mm3, with 35% segmented neutrophils, 60% lymphocytes, and 5% eosinophils. The
hemoglobin was 11.4 g/dL, and there were 203,000 platelets/mm
3. Electrolytes, blood urea nitrogen, and creatinine were all within normal
limits. Antigens of respiratory viruses were not detected by immunofluorescence
of nasopharyngeal washings.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Cough - Case 4-3: 7-Month-Old Girl:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 40.6°C; RR, 60/min; HR, 168 bpm; BP, 102/55 mm Hg; SpO2, 99% in room air
Weight, 50th percentile; height, 75th to 90th percentile
Initial examination revealed an alert baby who was crying but consolable. She
appeared slightly pale. Physical examination was notable for an erythematous
right tympanic membrane and bilaterally injected conjunctiva with yellow
discharge. She had moderate rhinorrhea and some notable buccal thrush. Her
oropharynx was mildly erythematous. The chest examination was remarkable for an
elevated respiratory rate, but there were no retractions. She had fine
expiratory wheezes bilaterally, with decreased breath sounds at both bases. Her
skin exhibited a fine, erythematous, blanching maculopapular rash on her face
and torso (Fig. 4-3) and, to a lesser degree, on her extremities. Her palms and
soles were spared. The rash appeared confluent in her perineal area and torso.
The remainder of her physical examination was unremarkable.
IV. Diagnostic Studies
Laboratory analysis revealed a peripheral blood count of 10,900 WBCs/mm3, with 41% segmented neutrophils, 50% lymphocytes, 8% monocytes, and no band
forms. The hemoglobin was 10.6 g/dL, and there were 290,000 platelets/mm
3. A urinalysis was normal, and a chest roentgenogram revealed mild
hyperinflation and right middle lobe atelectasis with some peribronchial
cuffing.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Cough - Case 4-6: 4-Month-Old Boy:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 37.2°C; RR, 27 to 40/min; HR, 138 bpm; BP, not obtained; SpO2, 96% in room air and decreasing to 93% with feeds
Weight, 25th percentile
On examination, he was alert with moderate respiratory distress and frequent
episodes of coughing. His chest examination was significant for grunting with
substernal, intercostal, and supraclavicular retractions. Rales were
appreciated on the right with good aeration throughout. No wheezes were heard.
The remainder of his physical examination was within normal limits.
IV. Diagnostic Studies
The complete blood count revealed 25,400 WBCs/mm3, with 51% lymphocytes, 17% atypical lymphocytes, 25% segmented neutrophils, and
6% monocytes. The hemoglobin was 12.3 gm/dL, and the platelet count was
494,000/mm
3.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Diarrhea - Case 17-1: 2-Month-Old Boy:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 36.9C; RR, 32/min; HR, 136 bpm; BP, 100/54 mm Hg
Weight, 5th percentile
On examination, the infant was alert and in no acute distress. His head, neck,
cardiac, and respiratory examinations were unremarkable. He was well hydrated
with a nontender and nondistended, soft abdomen. There was no
hepatosplenomegaly. There were no abdominal masses. He had normal male
genitalia, with bilaterally descended testicles. A tender, firm, and
erythematous mass measuring 5
× 3 cm was palpable in the right inguinal region.
IV. Diagnostic Studies
The complete blood count revealed 10,100 white blood cells (WBCs)/mm3, with 11% segmented neutrophils and 76% lymphocytes). The hemoglobin was 10.8
g/dL with a mean corpuscular volume of 87 fL, and the platelet count was
387,000 mm
3. Serum electrolytes, blood urea nitrogen (BUN), and creatinine values were
normal.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Diarrhea - Case 17-4: 15-Month-Old Boy:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 36.8°C; RR, 26/min; HR, 100 bpm; BP, 102/53 mm Hg
Weight, less than 5th percentile (50th percentile for a 6-month-old child);
height, 10th percentile
The initial examination revealed a quiet, gaunt-appearing child. His eyes were
sunken, but the rest of the head, eyes, ears, nose, mouth, and throat
examination was unremarkable. His cardiac and respiratory examinations were
normal. His abdominal examination revealed no masses. His liver edge was
palpable at the right costal margin. There was no clubbing of the fingers. He
had dry skin around his nose and lips. He had very little subcutaneous fat. His
neurologic examination was nonfocal.
IV. Diagnostic Studies
Laboratory analysis revealed 11,100 WBCs/mm3 with 29% segmented neutrophils, 66% lymphocytes, and 5% monocytes. The
hemoglobin was 12.2 g/dL, and there were 492,000 platelets/mm
3. Electrolytes were significant for a potassium concentration of 2.8 mmol/L and
a bicarbonate concentration 16 mmol/L. His ESR was 4 mm/hour. Urinalysis was
negative, with a urine specific gravity of 1.005. The serum alkaline
phosphatase level was low at 115 U/L, whereas ALT was elevated at 59 U/L, AST
at 64 U/L, and lactate dehydrogenase at 845 U/L.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Fever - Case 11-1: 18-Month-Old Girl:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 39.1°C; RR, 26/min; HR, 132 bpm; BP, 97/53 mm Hg; SpO2, 98% in room air
Weight, 25th percentile
The child was crying and seemed mildly disoriented. There were no bruises or
abrasions on her face or scalp. Her tympanic membranes were mildly erythematous
but mobile. There was copious purulent nasal discharge. The neck was difficult
to assess due to the child
's lack of cooperation. While yelling and screaming, she was able to arch her
back and neck without apparent limitation. There was no cervical
lymphadenopathy. The heart and lung sounds were normal. The abdomen was soft
without organomegaly. There were no focal neurologic deficits, but the child
appeared groggy and irritable and was slow to respond to her mother
's voice. Several hyperpigmented macules were noted on her skin as her clothes
were removed for the lumbar puncture (Fig. 11-1).
IV. Diagnostic Studies
A complete blood count revealed the following: 15,500 white blood cells
(WBCs)/mm
3 (61% segmented neutrophils, 22% lymphocytes, 15% monocytes, and 2%
eosinophils); hemoglobin, 12.1 g/dL; and 282,000 platelets/mm
3. Serum electrolytes, calcium, and glucose were normal. Urinalysis revealed no
WBCs or nitrites. Lumbar puncture revealed 2 WBCs and 19 red blood cells per
cubic millimeter. No bacteria were visualized on Gram staining. The
cerebrospinal fluid (CSF) protein and glucose concentrations were normal. Blood
and CSF cultures were subsequently negative.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Fever - Case 11-4: 7-Month-Old Girl:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 40.3°C; RR, 50/min; HR, 160 bpm; BP, 104/60 mm Hg; SpO2, 98% in room air
Weight, 75th percentile
Examination revealed an ill but not toxic-appearing infant. The anterior
fontanel was open and flat. Tympanic membranes were mildly erythematous but had
normal mobility bilaterally. There were no oropharyngeal lesions. Capillary
refill was brisk. The heart and lung sounds were normal. The spleen was
palpable just below the left costal margin. Examination of the genitalia
revealed significant erythema and induration of the left labia majora with mild
fluctuance. There was no crepitus. There were no other skin lesions.
IV. Diagnostic Studies
The WBC count was 3,100/mm3, with 2% segmented neutrophils, 28% monocytes, and 70% lymphocytes. The
absolute neutrophil count (ANC) was 62 cells/mm
3. Hemoglobin was 12.3 mg/dL, and platelets were 337,000/mm3. A repeat complete blood count produced similar results. Lactate dehydrogenase
and uric acid concentrations were normal. Urinanalysis did not reveal pyuria or
hematuria. Blood and urine cultures were obtained.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Jaundice - Case 15-1: 14-Day-Old Boy:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 36.4°C; RR, 48/min; HR, 140 bpm; BP, 83/50 mm Hg
Weight, 2.7 kg
Physical examination revealed a 2-week-old term boy who was listless but
arousable. His skin demonstrated a yellow-green jaundice but no petechiae,
rash, or bruising. He was nondysmorphic and normocephalic, with an open, flat
fontanel. His pupils were equal, round, and reactive with red reflexes present
bilaterally. Mucous membranes were yellow-pink and slightly dry. His
respirations were slightly rapid but otherwise unlabored with clear breath
sounds bilaterally. The heart examination was normal. The abdomen was soft and
nondistended, with a smooth, firm liver edge palpable 3 cm below the right
costal margin. Examinations of the genitalia and extremities were normal. His
tone, power, and primitive reflexes all appeared to be within normal limits.
IV. Diagnostic Studies
A complete blood count revealed the following: white blood cells (WBCs),
9,400/mm
3 (1% band forms, 41% segmented neutrophils, and 45% lymphocytes); hemoglobin,
16.0 g/dL; and platelets, 66,000/mm
3. PT and PTT were markedly prolonged at 50 and 112 seconds, respectively.
Fibrinogen was 127 mg/dL, and fibrin split products were negative. Serum
bicarbonate was 17 mEq/L, but the remainder of the serum electrolytes, calcium,
magnesium, and phosphorus were normal. Serum glucose was 52 mg/dL. A hepatic
function panel revealed the following: alanine aminotransferase (ALT), 115 U/L
aspartate aminotransferase (AST), 126 U/L; alkaline phosphatase, 730 U/L;
γ-glutamyl transferase (GGT), 55 U/L; and albumin, 3.5 mg/dL. The unconjugated
bilirubin concentration was 13.1 mg/dL, and the conjugated bilirubin was 5.9
mg/dL.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Jaundice - Case 15-3: 2-Month-Old Boy:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 37.3°C; RR, 24/min; HR, 140 bpm; BP, 96/60 mm Hg
Weight, 3.6 kg (less than 3rd percentile); length, 52 cm (less than 3rd
percentile); head circumference, 38 cm (10th percentile)
Physical examination revealed a cachectic, somewhat icteric 2-month-old boy in
no apparent distress. There was scleral icterus and a 5
× 5 cm anterior fontanel; the oropharynx was clear, with moist mucous membranes.
His neck was supple without lymphadenopathy or masses. Breath sounds were clear
and unlabored. His pulse was regular, and there was no murmur. The abdomen was
soft, nontender, and nondistended; the liver edge was palpable just below the
right costal margin, and a small umbilical hernia was present. The testes were
palpable (but not fully descended) bilaterally; the penis appeared small, with
a stretched penile length of 2.0 cm. The baby appeared alert with grossly
normal tone and reflexes. The remainder of the examination was unremarkable.
IV. Diagnostic Studies
Serum electrolyte measurement revealed the following: sodium, 131 mEq/L;
potassium, 4.1 mEq/L; chloride, 100 mEq/L; bicarbonate, 22 mEq/L; BUN, 14
mg/dL; creatinine; 0.2 mg/dL; and glucose, 50 mg/dL. The complete blood count
revealed 8,000 WBCs/mm
3 with 5% band forms, 30% segmented neutrophils, and 52% lymphocytes. The
hemoglobin was 9.2 g/dL, and the reticulocyte count was 1.7%. The total
bilirubin measured 10.5 mg/dL; the direct and unconjugated bilirubin levels
were 1.5 and 9.0 mg/dL, respectively. Serum albumin was normal. ALT was 46 U/L,
AST was 87 U/L, and GGT was 125 U/L.
Abdominal ultrasound examination of the liver revealed normal size, slightly
increased echogenicity, and a small, nondistended gall bladder without biliary
dilatation. The spleen and kidneys were normal. A sweat test was attempted, but
an insufficient amount of sweat was obtained to properly interpret the test.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Jaundice - Case 15-4: 6-Week-Old Girl:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 37.0°C; RR, 32/min; HR, 136 bpm; BP, 88/60 mm Hg
Weight, 4.1 kg (10th to 25th percentile); length, 56 cm (25th to 50th
percentile)
On examination, the infant was resting quietly in her mother's arms and was observed to have a mild “muddy” jaundice in her face. She was nondysmorphic and normocephalic, with an open,
flat fontanel. Scleral icterus was pleasant. There was no nasal discharge or
flaring. The oropharynx was clear, with moist mucous membranes. The lung and
cardiac examinations were normal. Her abdomen was soft and nondistended, and a
smooth, firm liver edge palpable 2 cm below the right costal margin. The
genitourinary, extremity, and neurologic examinations were all normal.
IV. Diagnostic Studies
The complete blood count revealed the following: 6,900 WBCs/mm3 (43% segmented neutrophils and 48% lymphocytes); hemoglobin, 9.2 g/dL; and
332,000 platelets/mm
3. Total bilirubin was 9.5 mg/dL, and the direct bilirubin concentration was 8.4
mg/dL. ALT and AST were 267 and 288 U/L, respectively. Albumin was 3.2 g/dL,
and the alkaline phosphatase was 641 U/L. Serum electrolytes, BUN, creatinine,
and glucose were normal. Calcium was also normal. Urinanalysis revealed a
specific gravity of 1.015 and 1+ blood but no nitrites, leukocyte esterase,
protein, or urobilinogen.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Jaundice - Case 15-6: 5-Week-Old Girl:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 37.2°C; RR, 28/min; HR, 120 bpm; BP, 80/56 mm Hg
Weight, 3.35 kg (5th percentile); length, 51 cm; head circumference, 36 cm
The infant appeared small but comfortable in her father's lap. She had an open, flat fontanel and a broad forehead; equal and round
pupils; and scleral icterus. The oropharynx was clear with moist mucous
membranes. Respirations were clear and unlabored. Cardiac examination revealed
a II/VI systolic murmur that was loudest at the left sternal border; the rate,
rhythm, and distal pulses were all normal. Her abdomen was soft and
nondistended, with a smooth liver edge palpable 3 cm below the right costal
margin; no spleen or other masses were appreciated. The genitourinary,
extremity, and neurologic examinations were all normal.
IV. Initial Diagnostic Studies
A complete blood count revealed the following: 16,700 WBCs/mm3 (31% segmented neutrophils and 61% lymphocytes); hemoglobin, 9.6 g/dL; and
625,000 platelets/mm
3. The BUN and creatinine concentrations were 26 and 1.1 mg/dL, respectively.
Serum electrolytes were normal. The total bilirubin concentration was 11.0
mg/dL; unconjugated and conjugated bilirubin were 8.0 and 3.1 mg/dL,
respectively. The remainder of the hepatic function panel was as follows: ALT,
190 U/L; AST, 94 U/L; albumin, 3.0 mg/dL; and alkaline phosphatase, 450 U/L.
Blood and urine cultures were obtained and were negative. Evaluations for
toxoplasmosis, rubella, cytomegalovirus, and HIV were also negative.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Pallor - Case 10-1: 3-Week-Old Boy:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 36.7°C; RR, 46 to 66/min; HR, 166 to 230 bpm; BP, 70/37 mm Hg
Weight, 3.1 kg (25th percentile); height, 50 cm (50th percentile); head
circumference, 36 cm (approximately 75th percentile)
On examination, the infant awakened easily and cried. He was remarkably
pale-appearing. The anterior fontanel was open and flat. The conjunctivae were
pale. The sclerae were anicteric. Mucous membranes were moist. The clavicles
were intact. The infant was tachypneic, but the lungs were clear to
auscultation. On cardiac examination, normal first and second heart sounds (S1
and S2, respectively) were heard. A III/VI systolic murmur was best appreciated
at the left upper sternal border. There were no gallops or rubs. No murmurs
were heard along the back. The liver edge was just palpable, but the spleen was
not palpable. The area of known extremity fracture had minimal edema but no
tenderness. There was some widening of the right distal femur compared with the
left. The remainder of the examination was normal.
IV. Diagnostic Studies
Complete blood count revealed the following: 11,300 white blood cells (WBCs)/mm3 (1% metamyelocytes, 43% segmented neutrophils, 34% lymphocytes, and 19%
monocytes); hemoglobin, 3.9 g/dL; 430,000 platelets/mm
3; MCV, 117 fL; RBC distribution width (RDW), 17; and reticulocyte count, 0.3%.
The peripheral blood smear revealed a few small spherocytes but no
schistocytes, burr cells, or target cells.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Pallor - Case 10-2: 12-Month-Old Girl:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 36.1°C; RR, 38/min; HR, 145 bpm; BP, 97/53 mm Hg; SpO2, 99% in room air
Weight, 79th percentile; height, 50th percentile
She was pale but alert and playful. The conjunctivae were pale but without
injection or discharge. There was no lymphadenopathy. Her neck was supple. A
II/VI systolic murmur was heard at the left upper sternal border without
radiation. The lungs were clear to auscultation. There was no splenomegaly or
hepatomegaly. There were no rashes or petechiae.
VI. Diagnostic Studies
The complete blood count obtained when the child was 6 months of age revealed
the following: 15,200 WBCs/mm
3 (71% segmented neutrophils, 25% lymphocytes, and 4% monocytes); hemoglobin,
11.2 g/dL; and 365,000 platelets/mm
3. At that time, the MCV was 78 fL and the RDW was 17.3.
Her current studies revealed the following: 8,300 WBCs/mm3 (58% segmented neutrophils, 31% lymphocytes, and 11% monocytes); hemoglobin,
3.4 g/dL; and 410,000 platelets/mm
3. The MCV was 59 fL, and the RDW was 15.1. The reticulocyte count was 1.4%.
Stool was Hemoccult negative.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Pallor - Case 10-3: 5-Month-Old Boy:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 38.4°C; RR, 58/min; HR, 160 bpm; BP, 83/38 mm Hg
Weight, 5.7 kg
In general, the child was lethargic and responsive only to painful stimuli. He
also had severe respiratory distress. The anterior fontanel was sunken. The
pupils were equal, round, and reactive to light. The conjunctivae and oral
mucosae were pale. The lips were dry and cracked. There were white patches on
the buccal mucosa that were easily removed with scraping. There was shotty
anterior and posterior cervical adenopathy. The lungs were clear to
auscultation, but the child had mild grunting and flaring. There was a II/VI
systolic ejection murmur at the left lower sternal border. The abdomen was
firm, with a liver edge palpable 5 cm below the right costal margin. The spleen
was palpable at the level of the umbilicus. Bowel sounds were present. The
extremities were cool with delayed capillary refill (5 seconds). On neurologic
examination, the child localized pain but had decreased tone and diminished
spontaneous activity.
In the emergency department, the patient had an oxygen saturation of 94% in room
air. He received several normal saline boluses as well as sodium bicarbonate
and intravenous dextrose. Blood and urine cultures were obtained. Intravenous
cefotaxime was given for presumed sepsis.
IV. Diagnostic Studies
The complete blood count revealed the following: 14,100 WBCs/mm3 (2% band forms; 52% segmented neutrophils, 42% lymphocytes, 2% eosinophils, and
2% atypical lymphocytes); hemoglobin, 2.6 g/dL; 184,000 platelets/mm
3; MCV, 88 fL; RDW, 17.4. The total bilirubin was 4.6 mg/dL with an unconjugated
level of 3.8 mg/dL. Hepatic transaminases, were normal but the lactate
dehydrogenase level was 2,984 IU/L (normal range, 934 to 2,150 IU/L). The chest
radiograph was normal. There was no cardiomegaly, infiltrates, or mediastinal
masses.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Rash - Case 9-2: 7-Week-Old Girl:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 37.0°C; RR, 43/min; HR, 180 bpm; BP, 113/53 mm Hg
Height, 50th percentile; weight, 50th percentile
The physical examination was remarkable for a hemangioma of the left occiput, a
hematoma of the tip of the tongue, and two ecchymotic areas on the right
mandible, each about 1 cm in diameter. She had three 3- to 4-cm ecchymotic
areas on the left back. A caf
é-au-lait macule (1 cm) was seen on the left thigh. Lungs were clear. Cardiac
examination revealed tachycardia but no murmurs, rubs, or gallops. There was no
hepatosplenomegaly and no prominent adenopathy. Neurologically she was alert,
crying, and moving all extremities. Funduscopic examination revealed right
retinal hemorrhages. The rest of her examination was normal.
VI. Diagnostic Studies
Laboratory analysis revealed 18,800 WBCs/mm3, with 39% segmented neutrophils, 49% lymphocytes, and 11% monocytes. The
hemoglobin was 11.4 g/dL, and there were 406, 000 platelets/mm
3. PT and PTT were normal. Electrolytes, BUN, and creatinine were normal.
Alkaline phosphatase was 270 mU/mL. Other liver function studies were as
follows: alanine aminotransferase, 100 IU/L; aspartate aminotransferase, 220
IU/L; and
γ-glutamyltransferase, 46 IU/L. Examination of the cerebrospinal fluid revealed 8
WBCs/mm
3and 5,250 red blood cells/mm3. The glucose concentration was 60 mg/dL, and the protein concentration was 36
mg/dL. There were no organisms on Gram staining of the CSF.
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Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
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