A Case of Megaspleen With Micrographism

Wilson disease is an inherited disorder of copper metabolism with an autosomal recessive inheritance pattern (hepatolenticular degeneration). In this case, a 13-year-old child was seen with overall exhaustion, sporadic abdominal discomfort, and shrinking handwriting during the previous 12 months. On clinical examination there was hepatosplenomegaly. Routine blood work revealed anemia, leukopenia, thrombocytopenia, elevated total and indirect bilirubin, alkaline phosphatase and transaminitis. Serum ceruloplasmin is decreased, urine copper excretion is increased. Slit lamp examination revealed Kayser-Fleischer rings in both eyes. Ultrasonography (USG) abdomen confirmed hepatosplenomegaly, coarse echotexture of the liver. MRI Brain revealed the bilateral and diffuse and symmetric hyperintensity of caudate and lentiform nuclei, which are consistent with the neuro-parenchymal changes of Wilson’s disease. We report this case due to its rare incidence and atypical presentation and to highlight the importance of clinical examination in reaching the diagnosis.