CLINICAL QUIZ

Abstract

A 12-year-old Nigerian girl presented at the Paediatric Gastroenterology Clinic following two episodes of haematemesis and persistent melaena. She had an upper GI endoscopy procedure and thereafter did not return to the hospital for further care due to financial handicap. She presented nine months later with recurrent haematemesis, easy fatigability, and lower limb swelling over the preceding three months. There was associated progressive exertional dyspnoea of recent onset. On physical examination, she was pale, lethargic, and had bilateral pitting pedal oedema up to the upper third of the legs. The pulse rate was 100 bpm, the respiratory rate was 34 cycles per minute, and there was a loud pulmonic component of the second heart sound.