An 11-year-old boy presented with a 4-week history of fever and 2 weeks later developed a cough with breathlessness. His chest X-ray showed bilateral miliary shadows with pneumothorax on the left side. While on antituberculous therapy which was started on admission, he developed right-sided pneumothorax with significant collapse of the left lung. He was managed by tube thoracotomy with underwater seal but died 4 hours after the procedure was completed.
A 12-year-old boy presented with a 5-month history of yellowness of the eyes, progressive painless abdominal swelling and weight loss. Physical examination revealed a grossly wasted child with marked jaundice and non-tender hepatomegaly. Liver function tests and abdominal ultrasound suggested obstructive liver disease. Tissue biopsy at laparotomy showed histological findings consistent with Burkitt's lymphoma. He was commenced on cytotoxic chemotherapy and, after two courses, the jaundice disappeared and he remained well. Although ante-mortem presentation of Burkitt's lymphoma as hepatic disease is rare, this condition should be included in the differential diagnosis of a child with obstructive jaundice.
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