A 12 year old boy studying in class 6 was brought by his parents with c/o decreased social interaction, less talking with family members, low mood and decreased sleep for last 20 days. On further evaluation, a h/o moderate grade fever with symptoms suggestive of URTI that persisted for 7 days was found to occur 10 days before the onset of the presenting symptoms. Physical examination revealed nothing abnormal. On mental status examination, he was found to be evasive, giving negative replies to questions asked in an endeavour to get access to his mood symptoms. He denied having any problem both at home and school setting.
Routine blood examination revealed CBC-WNL, total bilirubin 1.0mg/dl. Renal function WNL, widal test done at the time of fever yielding negative titres. How to approach and manage the case? I have ordered for an ASO titre assay considering his fever and URTI history.
