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Ask Dr. Yogindra Vasavada Your Own Question
Dr. Yogindra Vasavada
Dr. Yogindra Vasavada, Pediatrician
Category: Pediatrics
Satisfied Customers: 3095
Experience:  M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
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I have had a very ill child long as I can remember.

Customer Question

I have had a very ill child for as long as I can remember. Had had an immune work up years ago from the many infections he has had and hospital stays. He has lost 30 percent hearing in his ear from the surgeries and infections/ colesteotoma. He is now presenting with tics( pretty bad ones) pectichie on his skin and mouth(with ulcers) headaches, fatigue. His monocytes % have increased the past 4 blood draws, now over 12.2 but increased each draw regardless of the infection he was fighting at the time. His MPVs have always been low around 6 and are now normal which has never happened... I know that's an odd thing to say but it's odd for him. His RBC is always low, not terrible but low 4. Obviously I know that this can be a "virus" but I am not comfortable with as I'll as he always has been and now with the pechitchie and headaches. I will even say he has Tourette's with the tics. But I have this out in my stomach something is not right.
Submitted: 2 years ago.
Category: Pediatrics
Expert:  Pediatric2000 replied 2 years ago.
Does he have fever presently?Has the doctor thought of meningitis?have you shown to the ER?
Customer: replied 2 years ago.
He had meningitis two months ago.. He is sick often.... I have not gone to ER... Went to Pedi... He does not currently have fever. Has not during this "virus" just tired - brushing- ulcers- headaches. And the increasing blood work... Monocytes at 12.2 percent...
Expert:  Pediatric2000 replied 2 years ago.
Increase in the monocyte count along with petechie and mouth ulcers ,, headaches : There is definitely something wrong with respect to the system and things that should be considered are a meningitis ( meningococcal ) petechiae are commonly seen , Viral ( infectious mononucleosis , EBV related or even encephalitis should be considered.The conditions should be investigated by a blood antibody levels. His platelet count should be checked as we need to rule out Dengue , Malaria and the above conditions. If headache persists , a fundoscope examination to rule out increased intracerebral pressure should be done . A CSF study also can be done if the above tests suggested dont reveal anything. Have you thought in this direction as yet?
Customer: replied 2 years ago.
He has had ebv viral menigitits and this is t the same. The headaches are sporadic. Whereas with the menigitits it just increases and got worse. They did a CBC platlets were fine. The monocytes increasing have slowly increased the last year each blood draw. And now are over normal limits. Even when having menigitits his monocytes were normal. I would like to avoid a csf as he has had 2 in the past and have not been good experiences.. I don't know... He is very sick very often... 7 years old and in hospital more then the entire family in our lives. He has an immunology appt today. Hopefully I will get some answers there
Expert:  Pediatric2000 replied 2 years ago.
Yes , the immunology testing should help in giving a further insight into the reason for chronic meningitis like picture. Sporadic headaches , petechiae , can be of an autoimmune nature.A skin biopsy can also give better hints.Immunological assay before that would be helpfulDo you Agree with what i have mentioned?
Customer: replied 2 years ago.
That is why I am bringing him to a immunologist. I'm not getting any answers to what I don't already know. I will just wait and see what the immunologist has to say and take it from there. I was hoping for some insite as to the cause of the steady increase of his monocytes... And his chronic illnesses for 7 years... I will see what the specialist says
Expert:  Pediatric2000 replied 2 years ago.
Thank you for your reply. You do not think the monocyte increase can be related to the EBV or the chronic meningitis?You are aware that the monocyte levels are related to the viral pathology.Petechiae can be due to the an autoimmune in nature and that is why I had suggested an immunoloy reference.What are the answers that you are specifically looking for?
Customer: replied 2 years ago.
He doesn't have menigitits ebv currently and has high monocytes... When he had menigitits he didn't have high monocytes. I suggested an immune doctor because I had one today. It's ok she has ordered quite a few tests and hope to have an answer in a few weeks. I will have to wait until then
Expert:  Pediatric2000 replied 2 years ago.
Presently he does have petechiae?Do you have a photo of the petechiae that you can send across to me?