[Tropmed-l] Case of fever and esplenomegaly

[Antônio Bandeira]

Dear Igor,

First of all I would like to know the results of blood cultures and if that
man had an echocardiography performed so we can be confident that Typhoid
fever and Endocarditis have been already excluded.

If both of the above mentioned conditions have already been excluded, then
I think this man must be investigated for the following conditions:

1) Even though he is 60-yr old I would request a PCR for CMV along with CMV
serology to exclude a disseminated CMV infection even though he is
apparently an immunocompetent patient;

2) I think this man may have an autoimmune condition and I would order an
extensive panel that would include ANA, anti-Ro, anti-La, anti-Sm,
anti-DNA, ANCA, anti-KLM-1, C3, C4, total complement...

3) We recently had a similar case here in Bahia but the bone marrow showed
extensive hematophagocytosis along with an elevated ferritin and
tryglicerides and the final diagnosis was Still's disease and the patient
was succesfully treated with corticosteroids and immunosupressors.

Best regards,

Dr. Antonio Bandeira
Infectious Diseases MD, MPH
-------------- Pr?xima Parte ----------
Um anexo em HTML foi limpo...
URL: <http://lineu.icb.usp.br/pipermail/tropmed-l/attachments/20120708/610d9174/attachment.htm>