[Tropmed-l] Case of fever and esplenomegaly

[gustavo romero]

Dear Igor,

Did you consider the possibility of Typhoid fever? It seems to me that
after 3 weeks of symptoms the clinical picture that you have described is
pretty compatible with.

Regards,
Gustavo


Gustavo Romero
Professor Adjunto
Faculdade de Medicina
Universidade de Brasília
Núcleo de Medicina Tropical
Fone: +55-61-3107-1843

Projeto LVBrasil
Fone: +55-61-3107-1840


2012/7/3 Igor Thiago Borges de Queiroz e Silva <igorthiago em usp.br>

> 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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