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What about Mantoux and baciloscopy ?<BR>
fungi?: histoplasma criptococo?<BR>
Non infectious: Sarcoidosis?<BR>
<BR>
Hope we all can help you and your patient <BR>
<BR>
<BR>
Gema Ponce Revilla<BR> <BR>
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<DIV id=SkyDrivePlaceholder></DIV>> Date: Tue, 10 Jul 2012 22:31:13 -0300<BR>> From: igorthiago@usp.br<BR>> To: tropmed-l@lineu.icb.usp.br<BR>> Subject: [Tropmed-l] Case of fever and splenomegaly 2 - Fever of Unknown Origin<BR>> <BR>> Hi, everybody!<BR>> I´m very pleased that this case has generated great discussion!<BR>> I´m sorry for the delay in these informations. It took into account <BR>> many of yours remarks, hoping joins them to the fullest, and many <BR>> tests are still ongoing.<BR>> Our patient remains febrile despite the previous use of ceftriaxone, <BR>> piperacillin / tazobactam, meropenem, vancomycin. Empirical treatment <BR>> with praziquantel, even without serologic status for schistosomiasis.<BR>> Currently, makes use of polymyxin B (D5) for treatment of <BR>> Acinetobacter baumannii tracheobronchitis and amphotericin B (D13) and <BR>> doxycycline (D5), the last two being empirical.<BR>> Last week, we began the use of prednisone (0.5 mg / kg / day), aiming <BR>> for the treatment of Still's disease.<BR>> <BR>> Laboratorial tests:<BR>> Anti- HIV negative, Anti-HCV negative, HbsAg negative<BR>> EBV Serology ? IgM negative / IgG positive<BR>> CMV Serology IgM negative / IgG positive<BR>> Dengue Serology IgM negative / IgG negative<BR>> Schistosomiasis (IFI) negative<BR>> Chagas Disease (EIA) negative<BR>> Leishmaniasis ? IFI negative and rK39 negative. ELISA in progress.<BR>> Leptospirosis (IFI) ? IgM and IgG negative<BR>> Widal reaction ? negative<BR>> Thick blood smear for Plasmodium ? negative<BR>> VDRL (anti- T. pallidum) negative<BR>> Protein electrophoresis (Total protein = 5,5) ? albumin=37,5%, ?1= <BR>> 12%, ?2= 10,7%, ?=10,8%, ?=29%<BR>> C3=102, C4=22, ANCA (c,p) negative, Anti-DNA negative, FAN postive <BR>> (cytoplasmic dense fine speckled) 1/160. Reumathoid factor = 9,6<BR>> Ferritin = 3337<BR>> Negative blood cultures ever<BR>> VHS=35mm/h (<10mm/h)<BR>> PCR=3,3 > 16,4 > 17,9 > 12,3 > 18,2<BR>> TGO/P=33/35<BR>> alkaline phosphatase = 575 (<390)<BR>> GGT=605 (<85)<BR>> BT= 2,7 / BI=2,1 > BT=1,7 / BI=0,3<BR>> Artherial Lactate = 1,2 (0,4-2,0)<BR>> Hb/Htc= 8,2/23,8 > 9,3/27,7 > 7,2/21,6<BR>> Leuc= 2200 (Eo=0; 72 Segm) > 2300 (Eo=2%; 72Segm) > 2700 (Eo=3%; 71% Segm)<BR>> Plq= 78000 > 52000 > 77000<BR>> <BR>> Imaging studies:<BR>> Transthoracic echocardiography without vegetations, and showing <BR>> moderate tricuspid valve insufficiency and mild mitral valve <BR>> insufficiency<BR>> Endoscopy normal<BR>> USG = homogenous splenomegaly + biliary gauge preserved<BR>> CT Thorax = Ill-defined opacities in frosted glass and confluent <BR>> perihilar, predominantly in the right upper lobe, suggestive of <BR>> partial filling of the space aerial + Small / moderate right pleural <BR>> effusion posterior free<BR>> CT abdomen = Liver shapes and dimensions preserved with radiodensity <BR>> homogeneous. Ectasia and hepatic vein of the splenic hilum. An <BR>> enlarged spleen (20x9x18), with regular contours and solid density of <BR>> the parenchyma. Prostate of dimensions increased with regular contours <BR>> and attenuation coefficients usual. Content in a small liquid volume <BR>> in the pleural spaces, with tenuous amorphous densification in the <BR>> lung bases.<BR>> <BR>> <BR>> We are having some limitations in others tests such as mild laboratory <BR>> infrastructure or release of health insurance. But I will fight on it <BR>> to search of a definitive diagnosis. I count on the help of you.<BR>> <BR>> More details later...<BR>> <BR>> Sincerely.<BR>> <BR>> <BR>> <BR>> -- <BR>> Igor Thiago Borges de Queiroz e Silva<BR>> Infectologista do Hospital Giselda Trigueiro - SESAP - Natal/RN<BR>> Mestrando do Departamento de Doenças Infecciosas e Parasitárias - FMUSP<BR>> Laboratório de Soroepidemiologia e Imunobiologia (LIM38) - IMT/USP<BR>> igorthiago@usp.br<BR>> <BR>> <BR>> <BR>> <BR>> _______________________________________________<BR>> TropMed-L mailing list<BR>> TropMed-L@lineu.icb.usp.br<BR>> http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/tropmed-l<BR></DIV> </div></body>
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