<s>[INST] Hi, Ny daughter Paige is now 4, and has had a massive splenomegaly since birth that doctors, paediatricins cannot find a cause for. She had a chronic cough for 3 years, and mucous poos which a natural therapist has succesfullt treated as leaky bowel . She has recently had chronic bleeding nose and her cuts and sores are healing slowly and looking inflamed. her spleen is 21cm and she has occasional hepatomegaly. She has been tested for everything including parasitic involvement. All her siblings are healthy. serology shows that she has had both CMV and Epstein-barr, but the haemotologist says that it is definately not the cause of the biggest spleen he has seen . Ultrasounds show an engorged spleen with no fibroid tissue and no portal flow froblems. She has always had pancytopenia, but lately her white cells have been much lower than usual. She has no autoimmune disorders, thalassemia, TB, Kala azar, or any of the thousand things tested for. She needs help. Thankyou for your time [/INST] Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. It appears that she is having a very through evaluation and seems like she is in the proper place to have this work-up. I think I shall only be able to add some diagnoses that you didn't mention: -Leukemia can cause both splenomegaly and pancytopenia. -Tuberculosis can cause splenomegaly and chronic cough. -Spleen may be enlarged in child with iron-deficiency anemia, hemolytic anemia, sickle cell anemia, and other hemoglobinopathies. -Leptospirosis. -Splenic vein thrombosis. -Splenomegaly is often accompanied by hepatomegaly. Hope I have answered your query. Let me know if I can assist you further. </s>