A one year old girl was admitted in the children ward of our hospital with the complaints of persistent diarrhoea, vomiting and failure to thrive. The child was rehydrated with intravenous fluids and appropriate antibiotics cover was given which included inj. ceftriaxone and syrup metronidazole. Red cell concentrates were transfused then to correct anaemia and dietary rehabilitation was started with rice cereals, lactose free milk and yoghurt. Despite this supportive therapy. complaints persisted. Considering persistent and GIT complaints like diarrhoea, vomiting, distension of abdomen, bloating and pain abdomen accompanied by failure to thrive, a therapeutic trial of anti-tuberculous treatment was given keeping in view the possibility of TB abdomen. Treatment included isoniazid, (5mg/kg body wt), pyrazinamide (25mg/kg body wt) and rifampicin (5mg/kg body wt). Child responded to the treatment after two weeks of anti-tuberculous treatment, loose motions settled, appetite improved and she started gaining weight.
After two months of anti-tuberculous treatment, the child started exhibiting certain dermatological manifestations including redness, itching and lesions over face and extremities which persisted despite application of different emollients. The rash progressed and transformed over the passage of time. There was skin erosion over the face with an erythematous base, which was clearly demarcated from the surrounding healthy skin. The skin over both wrist joints and the lower parts of the legs was dry, thickened, fissured and hyperkeratotic. Dermatological manifestations were accompanied by restlessness, lethargy and loss of appetite with typical distribution and form of skin lesions and poor response to different topical preparations; we considered the possibility of pellagra most likely due to isoniazid therapy. Isoniazid was omitted from the treatment and supplementation of niacin and other vitamins was given orally. Over a period of one week, skin lesions gradually started healing without any topical treatment; restlessness and irritability decreased and the child started taking feeds eagerly. Eggs and meat were added to the diet and child showed a significant response to therapeutic and dietary management. She was discharged symptom-free after two weeks of hospitalization with instructions to take one tsf of syrup vit B-complex, `/2 tab. of folic acid 5 mg once daily and dietary advice for a normal balanced diet.
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