A 10 Months Old Girl Presented With Vaginal Bleeding : A Case Report
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Vaginal bleeding is rare in prepubertal children and can be challenging to diagnose, requiring differentiation between infection, mechanical causes, or other aetiologies. A 10-month-old female was referred from her paediatrician with a complaint of vaginal bleeding with purulent discharge for three months prior to admission. She presented with abdominal distention for two days prior to admission and absence of urination for one day prior to admission. There was no history of trauma or abuse. Physical examination revealed abdominal distention and a mass-like, distended bladder on palpation without tenderness. Laboratory examination showed leukocytosis (18.7 × 10³/L), hypochromic microcytic anaemia (8.30 g/dL), hyperkalaemia (6.8 mmol/L), decreased renal function (estimated glomerular filtration rate 3 mL/min/1.73 m²), and metabolic acidosis consistent with acute kidney injury (AKI) failure. Urinalysis was normal. On the day of admission, abdominal X-ray showed an intra-abdominal mass suspected to be an umbilical mass or calcification. Abdominal ultrasound revealed ascites, an overdistended bladder with cystitis, duplex collecting system of the right kidney with moderate bilateral hydroureteronephrosis. Dialysis was planned due to AKI failure. One day after Foley catheter insertion, laboratory evaluation showed normal renal function, normokalaemia, and normal blood gas analysis. Dialysis was postponed. Voiding cystourethrography demonstrated an inflammatory process outside the uterus and bladder, chronic cystitis, and right duplex collecting system. Abdominal MRI revealed a solid sacrococcygeal mass. Laboratory evaluation showed leukocytosis (20.99 × 10³/L), hypochromic microcytic anaemia (7.20 g/dL), normal B-human chorionic gonadotropin (B-HCG), and elevated alpha-fetoprotein (AFP >20,000 ng/mL). Urinalysis showed high leucocyte count (308/hpf) and bacteria >10,000/L. Laparotomy with biopsy revealed a germ cell tumour.
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