[Tropmed-l] RES: Case of fever and esplenomegaly

[Luis Marcelo Aranha Camargo, MD, PhD]

TRY A BLIND TREATMENT FOR MALARIA. DO NOT EXCLUDE BRUCELOSIS. BEST REGARDS

----- Mensagem de valdirsa em netpoint.com.br ---------
     Data: Mon, 9 Jul 2012 21:08:51 -0300
     De: "Dr. Valdir Amato" <valdirsa em netpoint.com.br>
  Assunto: [Tropmed-l] RES:  Case of fever and esplenomegaly
       Para: 'Igor Thiago Borges de Queiroz e Silva'  
<igorthiago em usp.br>, tropmed-l-bounces em lineu.icb.usp.br,  
tropmed-l em lineu.icb.usp.br


> Please as the result of CK and LDH enzyme? 'There was a symptom of muscle
> pain? And platelet counts are presented as? Pneumonia appeared as
> condensation or interstitial was looking?
> Valdir Amato
>
> -----Mensagem original-----
> De: tropmed-l-bounces em lineu.icb.usp.br
> [mailto:tropmed-l-bounces em lineu.icb.usp.br] Em nome de Igor Thiago Borges de
> Queiroz e Silva
> Enviada em: terça-feira, 3 de julho de 2012 19:45
> Para: tropmed-l em lineu.icb.usp.br
> Assunto: [Tropmed-l] Case of fever and esplenomegaly
>
> 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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-- 
Luís Marcelo Aranha Camargo, MD, PhD
ICB5/USP-Monte Negro
Rua Francisco Prestes 1234
CEP 76.888-000
Monte Negro-Rondônia