[Tropmed-l] Case of fever and esplenomegaly

[Paulo Behar]

Carlos,
have you already discovered tha cause of dysphagia ?
The physical exam of liver and spleen was compatible with a history of 4
days in the early clinical picture?
When the patient worked as a truck driver, was he here in Rio Grande do
Sul, South Brazil?
Were Acute Chagas Disease and Paracoccidioidomycosis ruled out?
The evolution of the patient sugests the same disease during these 30 days?
Had the patient criteria for Systemic Inflammatory Response Syndrome? SIRS
may take its own course independent from the inicial trigger. Any
nosocomial infection? What is the radiologic pattern in the beginning?

Good luck!

Paulo Behar
Médico Infectologista
Santa Casa de Porto Alegre
http://paulobehar.org




2012/7/16 Anthony Bryceson <a.bryceson em doctors.org.uk>

> Dear Carlos
> Thanks. i don't know Brasil as well as I should.
> What lurks in the jungle by Manaus? What infections do truck drivers get
> in Brazil?
> What are the values of his blood count?
> What does cardiac examination show?
> Is the chest x-ray normal?
>
> a 60 year old married male, fever, hepatosplenomegaly, various negative
> investigations; pneumonia ?why.
>
> I would think especially of the granulomatous diseases (infections,
> sarcoidosis etc). You need blood cultures, and tissue for histology and
> culture.
>
> I would suggest the following:
> Look at least twice more for malaria, and if you have it in Brasil,
> babesia.
> Repeat the serology done so far, and add Serology for histoplasmosis and
> other Brazilian fungi that present llike this, toxoplasma, coxiella,
> brucella; you should use paired samples after one month of fever.
>
> Blood cultures - I am not sure that you have excluded typhoid, coxiella,
>  brucella,  endocarditis, (warn the laboratory about extended cultures for
> brucellosis.
>
> Liver biopsy for histology and culture for fungus, TB, leishmania,
> toxoplasma,
>
> I shall be very interested in Jamie's opinion, particularly of the
> non-infectious possibilities.
>
> Keep me in the loop; best wishes
> Anthony
>
> On 16 Jul 2012, at 10:13, Carlos Costa wrote:
>
> 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
>
>
>
>
>
> ______________________________**_________________
> TropMed-L mailing list
> TropMed-L em lineu.icb.usp.br
> http://lineu.icb.usp.br/cgi-**bin/mailman/listinfo/tropmed-l<http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/tropmed-l>
>
>
>
> --
> 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).
>
>
> Aviso: As informações contidas nesta mensagem são CONFIDENCIAIS,
> protegidas pelo sigilo legal, por direitos autorais e destinadas
> exclusivamente à pessoa ou organização para a qual a mensagem foi destinada.
> Warning: This message is meant only for the intended recipient of the
> transmission.  It is forbidden any unauthorized use, alteration,
> reproduction and distribution. If you are not the correct recipient, please
> notify us immediately by return e-mail and delete this message from your
> system.
>
>
>
> _______________________________________________
> TropMed-L mailing list
> TropMed-L em lineu.icb.usp.br
> http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/tropmed-l
>
>


-- 
Paulo Behar
Médico Infectologista
-------------- Pr?xima Parte ----------
Um anexo em HTML foi limpo...
URL: <http://lineu.icb.usp.br/pipermail/tropmed-l/attachments/20120719/6da18ca2/attachment-0001.htm>