[Tropmed-l] Case of fever and esplenomegaly

[Reynaldo Dietze]

Igor can you give more details on the hemogram?  If you have a recently 
one will be better. Some of the differential diagnosis raised by our 
colleges can be ruled out with the hemogram.

Reynaldo Dietze

**************************
Reynaldo Dietze
Diretor
Núcleo de Doenças Infecciosas - UFES
Av.  Marechal Campos, 1468  Maruípe    Vitória - ES 
CEP  29040-091      Tel/Fax   (55)  27 - 3335-7204





De:
Igor Thiago Borges de Queiroz e Silva <igorthiago em usp.br>
Para:
tropmed-l em lineu.icb.usp.br
Data:
08/07/2012 04:42
Assunto:
[Tropmed-l] Case of fever and esplenomegaly
Enviado por:
tropmed-l-bounces em lineu.icb.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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