[Tropmed-l] Case of fever and esplenomegaly

[Carlos Costa]

Dear Jim and Anthony,

What are your ideas about this case?

Cheers,

Carlos.

---------- Forwarded message ----------
From: Igor Thiago Borges de Queiroz e Silva <igorthiago em usp.br>
Date: 2012/7/3
Subject: [Tropmed-l] Case of fever and esplenomegaly
To: tropmed-l 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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-- 
Carlos H. N. Costa, MD, DSc.
Sociedade Brasileira de Medicina Tropical
(Brazilian Society of Tropical Medicine)
President

Universidade Federal do Piauí
Instituto de Doenças Tropicais Natan Portella
Rua Artur de Vasconcelos 151-Sul
64001-450 Teresina-PI
Brazil
Telephones: +55 86 3222-4377 (W),
+55 86 3221-3062 (W),
+55 86 3237-1075 (R).


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