[Tropmed-l] Case of fever and esplenomegaly

[Mauro Shugiro Tada]

Dear Igor, I agree with Marcus and Luiz Marcelo,  PCR for Plasmodium,
can be done in IMTSP or ICB-USP and treat malaria. We had a similar
case in which the patient remained hospitalized twenty-eight days when
the blade was positive for P. vivax, was treated and discharged within
48 hours.
Mauro Tada- CEPEM

.
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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