Here we have a 5yr old sick child presenting with failure to thrive with lymphadenitis, fever, rash, dysphagia & conjunctivitis; I would consider the following diagnosis for this immonocompromised host-
1. Disseminated Tuberculosis- As the child is so sick, I would think in terms of disseminated TB with secondary bacterial infection of the nodes. History of contact or family history of Kochs would be helpful. On examination-What are the vitals? Are the lymph nodes matted? What are the respiratory & PerAbdomenfindings? Investigations required- Hb,TLC,DLC,ESR Mantoux test,X-Ray chest & a lymph node biopsy after secondary infection has been treated.
2. Atypical Mycobacteria Infection(Disseminated)-Disseminated infection usually occurs in a AIDS patient.Same signs & symptoms as above.Definitive diagnosis would be by node excision & recovery of the organism.
3.AIDS-Past h/o recurrent infection &a family history & HiV testing like ELISA, PCR would help to reach a diagnosis.
4.Chronic Granulomatous Disease-Past h/o recurrent infections,family history, NBT test would lead towards the diagnosis.
5.Job Syndrome-Eosinophilia & increased IgE would be the features.
6.Cat scratch disease & Chlamydial Infection-can give rise to the same picture but the child is usually not so sick without features of immunocompromise unless these occur with AIDS.
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