[Tropmed-l] Case of fever and esplenomegaly

[Mitermayer Galvão dos Reis]

Has tested for Lepto ou Hantavirus?



Mitermayer G. Reis
Pesquisador Titular
Fundação Oswaldo Cruz (FIOCRUZ)
miter em bahia.fiocruz.br
Tel 55 71 3176-2202 
      55 71 3176-2205
      55 71 3176-2289

Em Jul 8, 2012, às 0:02, "Igor Thiago Borges de Queiroz e Silva" <igorthiago em usp.br> escreveu:

> Hi, everybody.
> I would like some help in a case here in Sao Paulo:
> 
> "Patient, 60 years, male, married, with no comorbidities, retired  
> truck driver, coming from Manaus / AM, where he lives in urban area  
> and has a place in the jungle.
> He arrived at the referring hospital with fever, myalgia, headache and  
> dysphagia for 4 days, when it came to travel. On examination, revealed  
> hepatomegaly (2 cm) and splenomegaly (below the left costal margin).  
> Normal cardiac and pulmonary auscultation. No palpable lymphadenopathy.
> Reported contact with flood water, where had rats in peridomicile.  
> Confirmed vaccination against yellow fever (2009). Social drinking,  
> denied smoking or illicit drug use. One sexual partner (wife). He  
> denied domestic animals, neither contact with birds or bats.
> Laboratory revealed pancytopenia, normal renal function, elevated  
> transaminase levels (300-400) and canalicular enzymes, total  
> bilirrubins (3) with predominance of direct fraction (2). USG  
> confirmed homogeneous hepatosplenomegaly.
> Serology: Anti-HAV IgG+, HBsAg negative, anti-HCV negative, anti-HIV  
> negative, schistosomiasis IgM and IgG negative, blood smear with  
> negative plasmodium research, test for leishmaniasis (rK39) negative.  
> Dengue IgM negative and IgG positive, IgM negative for leptospirosis  
> (confirmed one week later). Bone marrow aspirate without significant  
> changes (only karyolysis) and without the presence of parasites.  
> Immunohistochemistry unchanged.
> Evolves with persistence of fever, with the biggest increase of the  
> spleen in relation to the liver, confirmed by computed tomography. He  
> was transferred to ICU because of pneumonia and respiratory failure  
> after 15 days of hospitalization. Today, even without definitive  
> diagnosis after one month of research, he persists with fever!"
> 
> Any suggestions?
> 
> Hug´s
> 
> -- 
> Igor Thiago Borges de Queiroz e Silva
> Infectologista do Hospital Giselda Trigueiro - SESAP - Natal/RN
> Infectologista do Hospital ABC Unidade Cirúrgica - São Bernardo do Campo/SP
> Mestrando do Departamento de Doenças Infecciosas e Parasitárias - FMUSP
> Laboratório de Soroepidemiologia e Imunobiologia (LIM38) - IMT/USP
> igorthiago em usp.br
> 
> 
> 
> 
> 
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