[Tropmed-l] Case of fever and splenomegaly - updates

[Igor Thiago Borges de Queiroz e Silva]

Hi, folks!

Here are some updates on the case discussion:
Total cholesterol and triglycerides normal
anti-LKM negative
anti- Ro (SSA) = (+)
Anti-La (SSB) negative
Anti-Sm = ? (in process)
Toxoplasmosis IgG+ IgM-
Brucelosis negative
Histoplasmosis negative
Toxocariasis IgM- IgG inconclusive
Malaria serology IgM-  IgG= 1:80 (normal 1:40)
BAL - Fast Acid Bacili negative, fungal negative
Mantoux = zero
Siphylis serologi negative
Direct Cooms = negative
Hemoculture negative (13x)
Coproculture negative
Bone Marrow Aspirate culture negative
Reumathoid factor negative
Complet Blood Count (18/7):
SERIE VERMELHA
CONTAGEM DE HEMACIAS: 2,37 milhoes/mm3 DOSAGEM DA HEMOGLOBINA: 7,1  
g/dLAVALIACAO DO HEMATOCRITO: 22,1 %VOLUME GLOBULAR MEDIO: 93,2  
fLHEMOGLOBINA GLOBULAR MEDIA: 30,0 pgCONCENTRACAO DA HEMOGLOBINA GLOB  
MEDIA: 32,1 g/dLINDICE DE ANISOCITOSE (RDW): 14,5 %OBSERVACOES:-

SERIE BRANCA - LEUCOGRAMA
Valores AbsolutosCONTAGEM DE LEUCOCITOS: 10,8 mil/mm3BASOFILOS: 0 %0  
/mm3EOSINOFILOS: 0 %0 /mm3NEUTROFILOS MIELOCITOS: 0 %0 /mm3NEUTROFILOS  
METAMIELOCITOS: 0 %0 /mm3BASTOES: 7 %756 /mm3SEGMENTADOS: 82 %8.856  
/mm3LINFOCITOS: 6 %648 /mm3MONOCITOS: 5 %540 /mm3OBSERVACOES:-

CONTAGEM DE PLAQUETAS: 161 mil/mm3COMENTARIOS:

TGO= 28, TGP=58, Alkaline fosfatase = 701, GGT=695
Total bilirubine= 3,5 (Direct=2,8 / Indirect=0,7)

  The patient improved with early methylprednisolone (60mg/day), with  
cessation of fever and decrease in the spleen. He's still doing  
hemodialysis because acute renal failure.
  I believe it closes for Lupus criteria (4 criteria):
  pleural and pericardial effusion
  leucoenia and thrombocytopenia
  renal failure
  positive ANA

  I apologize for not answering all emails individually. So, I prefer  
to answer them at once with updates on the case.

Hugs!


-- 
Igor Thiago Queiroz
Infectologista do Hospital Giselda Trigueiro - SESAP - Natal/RN
Mestrando do Departamento de Doenças Infecciosas e Parasitárias - FMUSP
Laboratório de Soroepidemiologia e Imunobiologia (LIM38) - IMT/USP
igorthiago em usp.br