7 yr old child which recurring mouth ulcers, bloating and abd. pain

 NOTE:  THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT

PATIENT HISTORY: Pt. is a boy of 6yrs 9 months. He had no issues except 1-2 episodes of cough and cold with mild fever which lasted for 2-3 days. 18-19 months ago, one day while going to sleep at night he complained of diffused pain in his abdomen and bloating. Medicine at home did not resolve the pain, so after 10-12days went to Paediatrician, who gave medicine for 1 month. His stool was of normal consistency with frequency of 2-3 times. Everything was resolved with medication. 1 year later again same problem. Went to the same Dr. who again gave medicine for 1 month and everything resolved. But  4 months ago same problem of abd. pain and bloating. So, went to a different Dr. . Gave 1  month medicine. Was fine for 20-25 days. But again same problem of bloating and abd. pain. . Dr, again gave medicine but this time no recovery. 

For the last 10-12 days loose stool (3-4 times/day), which resolved after eating raw banana and giving ORS. In the year 2021, before Holi, he had an episode of high fever which lasted for 4 days (highest temp. 102 F). At that time his mouth was filled with ulcers. Dr. gave him A-Z syrup, Ca2+ for 1 yr. But she stopped after 4 months, thinking more medicine is not good. 

4 months ago, he again had an episode of fever occurring at night which lasted for 4-5 days (max temp 99-100 F). Ulcers inside the mouth are recurring and go away with medicine within 4-5 days. Reappears within a week. 

For the past 20 days, his mom noticed that till 11.30 am he is fine. But as the day progresses he starts complaining of bloating and abd. pain.His abd appears to be hard on touching.  And just after lunch (mostly) or dinner, he runs to the washroom for defaecation. His appetite has decreased. In March 2022, he had an penile infection (penis swelled up, painful and red). Dr. gave antibiotic and resolved within 4-5 days. Now, there is an itchy and burning sensation in the perineum, which reduces on using BEtamil GM, but reappears. 3-4 days ago, He complained of a lump in rt. side of his head which was painful on touch. Now the lump is there but no pain. 

The mother said that she fed him with baby food till 2.5 yrs age. And earlier he used to swallow food without chewing, but for the past 18 months, he is chewing food. 

FAMILY HISTORY: 

Mother had 3 issues. Pt is her Ist baby via Cesarean at age 25. 2nd Cesarean baby at age 28; survived after birth for only 1 day. Had situs inversus and ASD. Due to infection in the stitches, she had to undergo Sx twice. 3 months after Sx she conceived at age 30.

 Her third child has no health issues.

DIET: 

When normal :

Breakfast 8am - boiled egg/milk with puffed rice and banana, biscuits

11:30am - fish, daal, rice

2pm lunch - fish, daal, rice. ghee, Sometimes sabji small amount

Evening - milk, puffed rice, banana

Dinner - daal, omlette, rice, potato fry

When gastric issue:

No milk, egg, ghee, biscuits

Shinghi fish and rice

                                        

COURSE IN HOSPITAL :

The patient came with the above complaints and planned for CECT abdomen with enterography which showed subtle mucosal edema in the caecum and terminal ileum, multiple enlarged mesenteric lymph nodes in right iliac fossa and started him on Drotin sos

The patient is hemodynamically stable at the time of discharge 

Advice at discharge :

1) tab Drotin 40mg po sos

2) Syp Atarax 5ml po of

3) Permethrine lotion 5% on day 1 and day 8 all over body except face and scalp (  scabies trial)

DIAGNOSIS AT THE TIME OF DISCHARGE : Probable Inflammatory bowel disease since 18 months with predominant symptoms of irritable bowel syndrome