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Hussain H, Janaka C, Rodrigo AS, Krishnan M, Hassan A. Pyrexia of Unknown Origin Caused by Non-Hodgkin's Lymphoma: A Diagnostic Challenge for Clinicians. Cureus 2024; 16:e56742. [PMID: 38650785 PMCID: PMC11033217 DOI: 10.7759/cureus.56742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
Non-Hodgkin's lymphomas (NHLs) are a group of lymphoproliferative diseases that originate from different cell types, namely B cells, T cells, or natural killer cells. Herein, we report the case of a 69-year-old male patient who presented with a gradual-onset, intermittent, low-grade fever for four months and a right-sided neck lump for two months. On examination, a right-sided enlarged lymph node sized 1 × 1 cm2 was noted, which was mobile, hard in consistency, and non-tender. No other lymphadenopathy was noted in other parts of the body. Imaging and biochemical studies done at the initial stages did not reveal features in favor of any lymphoproliferative disorders, and the two lymph node biopsies done two weeks apart were inconclusive as well. An extended panel of investigations was done in view of excluding other infective and inflammatory pathologies, which was negative, making the patient undiagnosed of any disease state despite being symptomatic for four months. Finally, the third lymph node biopsy tested positive, which paved the way for the diagnosis of NHL. This diagnosis underlines the importance of this case. Following the diagnosis, the patient was initiated on a few chemotherapeutic agents, after which a mild symptomatic improvement was achieved.
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Affiliation(s)
- Hassan Hussain
- General Medicine, Sri Jayawardenepura General Hospital, Colombo, LKA
| | - Chaminda Janaka
- Internal Medicine, Sri Jayawardenepura General Hospital, Colombo, LKA
| | | | | | - Azra Hassan
- Oncology, District General Hospital Vavuniya, Colombo, LKA
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2
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Wright WF, Betrains A, Stelmash L, Mulders-Manders CM, Rovers CP, Vanderschueren S, Auwaerter PG. Development of a Consensus-Based List of Potential Quality Indicators for Fever and Inflammation of Unknown Origin. Open Forum Infect Dis 2024; 11:ofad671. [PMID: 38333881 PMCID: PMC10853001 DOI: 10.1093/ofid/ofad671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/22/2023] [Indexed: 02/10/2024] Open
Abstract
With a growing emphasis on value-based reimbursement, developing quality indicators for infectious diseases has gained attention. Quality indicators for fever of unknown origin and inflammation of unknown origin are lacking. An assembled group of international experts developed 12 quality measures for these conditions, which could be validated with additional study.
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Affiliation(s)
- William F Wright
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Albrecht Betrains
- General Internal Medicine Department, University Hospitals Leuven, Leuven, Belgium
| | - Lauren Stelmash
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Catharina M Mulders-Manders
- Division of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Chantal P Rovers
- Division of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Steven Vanderschueren
- General Internal Medicine Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Paul G Auwaerter
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- The Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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3
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Dhadwad JS, Kadiwala RS, Modi KK, Yadav PR, Vadivel SP. A Case of Pyrexia of Unknown Origin Diagnosed as Hemophagocytic Lymphohistiocytosis. Cureus 2024; 16:e53553. [PMID: 38445154 PMCID: PMC10913697 DOI: 10.7759/cureus.53553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/07/2024] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare disease that is even rarer in the adult population. It requires a high degree of suspicion from the treating physician, and if diagnosed early, patients might have a survival benefit from this highly fatal condition. HLH is a disorder of immune regulation where the hyperactivity of cytokines attacks different cells, which leads to multiple organ dysfunctions. Varying presentations and similarities with other diseases make diagnosis difficult. Familial HLH is commonly seen in the pediatric population, while acquired or secondary HLH is seen in adults. Secondary HLH is commonly triggered by neoplasms, infections, rheumatological diseases, and other autoimmune diseases. Here is a case of HLH that presented as chronic undiagnosed fever. In this case report, we have discussed in detail this disease, its presentation, investigations, treatment, and other important information that will help practicing doctors better diagnose and treat HLH patients.
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Affiliation(s)
- Jagannath S Dhadwad
- General Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, IND
| | - Ramiz S Kadiwala
- General Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, IND
| | - Kunal K Modi
- General Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, IND
| | - Prince R Yadav
- General Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, IND
| | - Subashini P Vadivel
- General Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, IND
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4
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Divyashree K, Singh H, Parkhi M, Karmakar I, Sachdeva MUS, Suri V, Bhalla A. Hemophagocytic Lymphohistiocytosis due to Disseminated Histoplasmosis in a Patient with HIV Infection. J Glob Infect Dis 2023; 15:124-126. [PMID: 37800079 PMCID: PMC10549904 DOI: 10.4103/jgid.jgid_190_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/28/2022] [Accepted: 01/23/2023] [Indexed: 10/07/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis is usually considered a rapidly progressive fatal illness with poor outcomes. It is of two types: primary or familial and secondary. In patients with HIV, opportunistic infections are the secondary triggers of HLH. First line of management of infection associated HLH is treatment of the underlying infection. Here, we present a case of HLH in HIV infection due to disseminated histoplasmosis managed with liposomal amphotericin B, who required immunosuppressive therapy with intravenous immunoglobulin and dexamethasone due to nonresponse to primary therapy.
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Affiliation(s)
- Krishna Divyashree
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harpreet Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mayur Parkhi
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Indrani Karmakar
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Man Updesh Singh Sachdeva
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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5
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Rathore H, Thaker N. A Rare Presentation of Tuberculosis in Transplanted Kidney on Fluorodeoxyglucose Positron Emission Tomography with Computed Tomography Scan. Indian J Nucl Med 2023; 38:177-179. [PMID: 37456186 PMCID: PMC10348506 DOI: 10.4103/ijnm.ijnm_129_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/07/2022] [Accepted: 12/24/2022] [Indexed: 07/18/2023] Open
Abstract
Tuberculosis (TB) is currently the world's leading cause of infectious mortality. Infective complications are common after renal transplantation. TB is one of the leading infections following renal transplantation; however, TB affecting the transplanted kidney is a rare presentation. Reactivation of the Mycobacterium tuberculosis is the most common mode of infection. The use of immunosuppressive agents such as cyclosporin, azathioprine, and steroids advance the onset of TB to an earlier date which most often presents as a fever or pyrexia of unknown origin (PUO). The use of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) scan images of the whole body and provides the metabolic map of the infection as well as also helps in its radiological localization and characterization and selecting the most appropriate site of the biopsy. Currently, the combined FDG-PET/CT scan modality is the investigation of the choice of physicians for the diagnosis of PUO. Not only the diagnosis but 18F-FDG-PET/CT is also very valuable in assessing early disease response to therapy, and plays an important role in cases where conventional microbiological methods are unavailable for monitoring response to the therapy in cases of pulmonary, extrapulmonary, or multidrug resistant TB.
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Affiliation(s)
- Hemant Rathore
- Department of Nuclear Medicine and PET CT, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Nirav Thaker
- Department of Radiodiagnosis, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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6
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Wright WF, Wang J, Auwaerter PG. Investigator-Determined Categories for Fever of Unknown Origin (FUO) Compared With International Classification of Diseases-10 Classification of Illness: A Systematic Review and Meta-analysis With a Proposal for Revised FUO Classification. Open Forum Infect Dis 2023; 10:ofad104. [PMID: 36949875 PMCID: PMC10026547 DOI: 10.1093/ofid/ofad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/22/2023] [Indexed: 02/26/2023] Open
Abstract
Background Classifying fever of unknown origin (FUO) into categorical etiologies (ie, infections, noninfectious inflammatory, oncologic, miscellaneous, and undiagnosed disorders) remains unstandardized and subject to discrepancies. As some disease classifications change, a systematic review of studies would help physicians anticipate the frequency of illness types they may encounter that could influence care. Methods We systematically reviewed prospective FUO studies published across the Medline (PubMed), Embase, Scopus, and Web of Science databases from January 1, 1997, to July 31, 2022. We performed a meta-analysis to estimate associated pooled proportions between the investigator-determined choice of disease category and those determined by the International Classification of Diseases, 10th edition (ICD-10), methodology. Results The proportion of patients with a difference between the investigator and ICD-10-adjusted noninfectious inflammatory disorder category was 1.2% (95% CI, 0.005-0.021; P < .001), and the proportion was similar for the miscellaneous category at 1.5% (95% CI, 0.007-0.025; P < .001). The miscellaneous and noninfectious inflammatory disorders categories demonstrated significant across-study heterogeneity in the proportions of patients changing categories, with 52.7% (P = .007) and 51.0% (P = .010) I2 , respectively. Conclusions Adjusting FUO-associated diagnoses by ICD-10 methodology was associated with a statistically significant risk of over- or underestimation of disease category frequency approximation when using a 5 FUO category system. An FUO diagnostic classification system that better reflects mechanistic understanding would assist future research and enhance comparability across heterogenous populations and different geographic regions. We propose an updated FUO classification scheme that streamlines categorizations, aligns with the current understanding of disease mechanisms, and should facilitate empirical decisions, if necessary.
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Affiliation(s)
- William F Wright
- Correspondence: William F. Wright, DO, MPH, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21205 (); or Paul G. Auwaerter, MD, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 725 North Wolfe Street, Baltimore, MD 21205 ()
| | - Jiangxia Wang
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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7
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Vishnoi MG, Jain A, Sharma A, Kapoor R, Mahato A, Tiwari A. 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scan Findings in a Rare Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Indian J Nucl Med 2023; 38:50-52. [PMID: 37180181 PMCID: PMC10171763 DOI: 10.4103/ijnm.ijnm_85_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/08/2022] [Indexed: 05/16/2023] Open
Abstract
Skin lymphomas are less common and subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a fairly rare subtype of primary cutaneous lymphoma. Skin lymphomas involve subcutaneous adipose tissues with no involvement of lymph nodes. Diagnosis of these cases is generally a challenge to clinicians. These cases present with fever, weight loss, and local discomfort in the region of involvement of subcutaneous tissues and sometime with skin eczema and rashes. Positron emission tomography/computed tomography (PET/CT) scan can guide in determining the extent of involvement being whole-body imaging and can guide the site of biopsy and can help to prevent misdiagnosis. It also helps in correct and early diagnosis and successful treatment. We report a case of a young adult who presented with pyrexia of unknown origin in which PET/CT scan revealed mildly fluorodeoxyglucose-avid diffuse subcutaneous panniculitis involving the whole body, trunk, and extremities. Biopsy was taken from the most appropriate site according to the PET/CT scan report and reported as SPTCL.
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Affiliation(s)
- Madan Gopal Vishnoi
- Department of Nuclear Medicine, Command Hospital Eastern Command, Kolkata, West Bengal, India
| | - Anurag Jain
- Department of Nuclear Medicine, Command Hospital Central Command, Lucknow, Uttar Pradesh, India
| | - Amit Sharma
- Department of Nuclear Medicine, Command Hospital Eastern Command, Kolkata, West Bengal, India
| | - Rajan Kapoor
- Department of Hemato-Oncology, Command Hospital Eastern Command, Kolkata, West Bengal, India
| | - Abhishek Mahato
- Department of Nuclear Medicine, Command Hospital Central Command, Lucknow, Uttar Pradesh, India
| | - Awadhesh Tiwari
- Department of Nuclear Medicine, Command Hospital Central Command, Lucknow, Uttar Pradesh, India
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8
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Howells P, Laird S, Johnston AM, Billyard T. Critical illness in the returning traveller. J Intensive Care Soc 2022; 23:87-92. [PMID: 37593535 PMCID: PMC10427841 DOI: 10.1177/1751143721991955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
A 70 year old man, who had recently travelled in rural Iraq, presented with fevers, rigors, and developed multiorgan failure. An extensive range of diagnostic tests was undertaken in an attempt to identify the cause. He was treated with multi-organ support and a number of antibiotics. Critical illness in the returning traveller presents a number of challenges on the ICU: obtaining adequate history, the potentially broad differential diagnosis, the requirement for numerous and sometimes specialised investigations and risks of infection transmission to staff and other patients. Travellers are more often elderly, more likely to have comorbidities and immunosuppression whilst global disease patterns are changing. Particular consideration should be given to unusual infections and venous thromboembolic disease from prolonged immobility whilst in transit, alongside more commonly encountered diseases. Antimicrobial resistance may be encountered and appropriate infection control is essential for the protection of patients, staff and others. Specialist support is available in the UK via the Imported Fever Service, especially for High Consequence Infectious Diseases. Consideration of non-infectious causes of fever and critical illness in returning travellers is also warranted. Crucially, a multidisciplinary team approach with thorough information gathering, repeated clinical review and judicious use of investigations are essential for optimal patient care.
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Affiliation(s)
- Phillip Howells
- Department of Anaesthesia and Critical Care Medicine, Harefield Hospital, London, UK
| | - Steven Laird
- Department of Microbiology, University Hospital Coventry, Coventry, UK
| | - Andrew McD Johnston
- Royal Centre for Defence Medicine, Birmingham, UK
- Department of Critical Care Medicine, University Hospital Birmingham, UK
| | - Thomas Billyard
- Department of Anaesthesia and Critical Care Medicine, University Hospitals Coventry and Warwickshire, UK
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9
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Singh J, Dinkar A, Gupta P. Uncommon manifestations in tuberculosis: An expanding clinical spectrum from North India. Int J Mycobacteriol 2022; 11:30-37. [PMID: 35295021 DOI: 10.4103/ijmy.ijmy_242_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Despite being given the best by the health department to eradicate the disease, an alarming rise of tuberculosis (TB) remains a significant public health concern in India. Recently, highly variable clinical manifestations of TB have been reported. This study highlights the unusual presentations of TB with a comprehensive overview of epidemiology, demography and risk factors in the expended clinical spectrum of TB patients and their outcomes. METHODS It is a retrospective study using the records of 503 TB patients of all age groups of either sex from July 2017 to January 2021 at two tertiary care hospitals in North India. RESULTS Out of 503 cases, pulmonary, extrapulmonary, and disseminated TB were 77.7%, 19.5%, and 2.8%, respectively. Among all TB cases, 36 (7.2%) had uncommon manifestations, including the most common was pyrexia of unknown origin in 12 (33.3%) cases and liver abscess in 5 (13.9%) cases, followed by pancytopenia in 4 (11.1%) cases and chyluria in 3 (8.3%) cases. Atypical skin nodules and multiple swellings were also noted in three (8.3%) cases. Male sex (58%) and rural area (66.7%) were dominant in TB with uncommon manifestation (TBU) cases. The mean age in TBU cases was 46.92 years, whereas 34.26 years in all TB cases. It was extremely significant. The statistically significant risk factors in the TBU case were low socioeconomic status (24, 66.7%), inadequate nutrition (11, 30.6%), and smoking (19, 52.8%). CONCLUSIONS Early recognition of uncommon presentations is imperative to respond better.
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Affiliation(s)
- Jitendra Singh
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anju Dinkar
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Poonam Gupta
- Department of Pathology, Popular Multispecialty Hospital, Varanasi, Uttar Pradesh, India
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10
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Farrukh H, VandenBerg C, Ertel E, Griffith H, Kelly B. Retinal Detachment and Temporal Artery Dissection: An Elusive Case of Giant Cell Arteritis. Cureus 2021; 13:e16703. [PMID: 34513351 PMCID: PMC8412197 DOI: 10.7759/cureus.16703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
Giant cell arteritis (GCA), also known as temporal arteritis, is the most common systemic inflammatory vasculitis occurring in the elderly. Patients usually present with vision loss, headache, jaw claudication, diplopia, myalgia and constitutional symptoms. The most common ocular manifestations are anterior ischemic optic neuropathy (AION), choroidal ischemia and central retinal artery occlusion. Here we describe a case of GCA presenting with vision changes secondary to retinal detachment and vitreous hemorrhage. Upon temporal artery biopsy, GCA was confirmed and it was found to be accompanied by temporal artery dissection as well. Patient was treated with pulse dose intravenous steroids after which her symptoms improved. Based on our literature review, this is the first reported case of GCA presenting in this manner.
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Affiliation(s)
- Hina Farrukh
- Internal Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
| | | | - Elisabeth Ertel
- Department of Medicine, Temple University, Philadelphia, USA
| | - Heidi Griffith
- Internal Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
| | - Brendan Kelly
- Internal Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
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Satyanarayan B, Sahu A, Prasad SK, Kumari S. Can Subacute Thyroiditis Be a Cause of Fever of Unknown Origin? Cureus 2021; 13:e16399. [PMID: 34408952 PMCID: PMC8362865 DOI: 10.7759/cureus.16399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/28/2022] Open
Abstract
Subacute thyroiditis (SAT) is a self-limiting, painful, non-suppurative thyroid gland inflammation, which usually develops two to eight weeks after viral upper respiratory tract infections, accompanied by pain and fever. The thyroid gland is large, painful, and tender. It presents with fever, myalgia, arthralgia, weakness, and sore throat. A 37-year-old male presented to medical ward with a history of fever for three weeks along with swelling of neck and difficulty in swallowing. The patient had features of hyperthyroidism. High-resolution ultrasonography (HRUSG) and thyroid scan were suggestive of thyroiditis. Later on, on follow-up, the patient developed hypothyroidism. He was managed with antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and glucocorticoids, and he responded well to the above treatment. The index patient presented as a case of fever which on workup was found to be secondary to subacute thyroiditis (SAT).
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Affiliation(s)
| | - Anupama Sahu
- Internal Medicine, Tata Main Hospital, Jamshedpur, IND
| | | | - Sarita Kumari
- Internal Medicine, Tata Main Hospital, Jamshedpur, IND
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12
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Abstract
Herein, we report a case of primary small cell neuroendocrine tumor (NET) of the gallbladder in a 45-year-old female who presented with complaints of fever accompanied by abdominal pain on the right upper quadrant for one month. Contrast-enhanced computed tomography abdomen showed a large gallbladder mass. It was infiltrating the segments IVa, IVb, and V of the liver. Ultrasound-guided fine-needle-aspiration-cytology was performed. Based on preoperative pathological and immunohistochemical investigations, it was diagnosed to be a primary small cell NET of the gallbladder. The patient underwent radical cholecystectomy after three cycles of cisplatin-based neoadjuvant chemotherapy. She had an uneventful recovery and received adjuvant chemo-radiotherapy. The patient was well at the 18-month follow-up.
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Affiliation(s)
- Arkadeep Dhali
- Department of Gastrointestinal Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, IND
| | - Sukanta Ray
- Department of Gastrointestinal Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, IND
| | - Gopal Krishna Dhali
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, IND
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13
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Tauseef A, Buragadda A, Nair S, Anum A, Zafar M. Antibiotic-Resistant Pyrexia of Unknown Origin: An Unusual Presentation of Myelodysplastic Syndrome. Cureus 2021; 13:e15739. [PMID: 34285848 PMCID: PMC8286634 DOI: 10.7759/cureus.15739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/05/2022] Open
Abstract
A 74-year-old male presented to the emergency department (ED) with complaints of high-grade fever, productive cough, and difficulty breathing for three weeks, and a significant weight loss in the past six months. Despite a detailed investigation, diagnosis could not be achieved. Multiple empiric regimens were tried but no response was observed. Bone marrow biopsy was conducted after suspicious peripheral film result, which concluded that the patient was having myelodysplastic syndrome. Although pyrexia of unknown origin has a diverse group of diseases to evaluate for, and rare entities are difficult to diagnose, meticulous evaluation may give significant evidence for targeted diagnostic workup.
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Affiliation(s)
- Abubakar Tauseef
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Avdesh Buragadda
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Sunil Nair
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Ayesha Anum
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Maryam Zafar
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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14
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Ginier-Gillet M, Esparcieux A. Habitual Hyperthermia: An Interpretive Paradigm of the 20th Century? Not Really. Int J Gen Med 2021; 14:2063-2068. [PMID: 34079346 PMCID: PMC8164870 DOI: 10.2147/ijgm.s306423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
Prolonged and unexplained fevers in young adults are uncommon, especially when access to diagnostic tests is simplified. Therefore, the definition of unexplained fever depends on the volume of tests performed. However, low-grade fever has not been a priority in research. Management of low-grade fever [eg, an oral temperature of ≥37.8°C (100°F) and <38.3°C (101°F) at any time of the day] is not codified. The presented case of a 37-year-old nurse with an intermittent fever for three months, with no clear diagnostic evidence and no elevated markers of inflammation, illustrates “habitual hyperthermia” (HH)—retained after ordering tests sequentially in town and at the hospital. HH was made known by Prof. H.A. Reimann (1897–1986) an American virologist, although the diagnostic criteria are fallible. The article reviews the criteria and then discusses how to select diagnostic tests in family practice for prolonged fever in young adults without clinical signs of orientation. Given the polymorphism of febrile illnesses, the principle of parsimony must be transgressed, and in the event of an early suspicion of HH, surveillance is a rule to be further amended.
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Affiliation(s)
| | - Aurelie Esparcieux
- Department of Internal Medicine and Infectious Diseases, Clinique de l'Infirmerie Protestante de Lyon, Caluire-et-Cuire, France
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15
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Wright WF, Auwaerter PG, Dibble EH, Rowe SP, Mackowiak PA. Imaging a Fever-Redefining the Role of 2-deoxy-2-[18F]Fluoro-D-Glucose-Positron Emission Tomography/Computed Tomography in Fever of Unknown Origin Investigations. Clin Infect Dis 2021; 72:1279-1286. [PMID: 32829386 DOI: 10.1093/cid/ciaa1220] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/21/2020] [Indexed: 12/21/2022] Open
Abstract
Growing evidence suggests that 2-deoxy-2-[18F]fluoro-D-glucose (18FDG)-positron emission tomography/computed tomography (PET/CT) is a useful imaging technique for the evaluation of fever of unknown origin (FUO). This imaging technique allows for accurate localization of foci of hypermetabolism based on 18FDG uptake in glycolytically active cells that may represent inflammation, infection, or neoplasia. The presence of abnormal uptake can help direct further investigation that may yield a final diagnosis. A lack of abnormal uptake can be reasonably reassuring that these conditions are not present, thereby avoiding unnecessary additional testing. Insurers have not routinely covered outpatient 18FDG-PET/CT for the indication of FUO in the United States. However, data published since 2007 suggest early use in FUO diagnostic evaluations improves diagnostic efficiency and reduces costs. Clinicians and insurers should consider 18FDG-PET/CT as a useful tool when preliminary studies are unrevealing.
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Affiliation(s)
- William F Wright
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul G Auwaerter
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Steven P Rowe
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Philip A Mackowiak
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Alcorn K, Gerrard J, Cochrane T, Graham R, Jennison A, Irwin PJ, Barbosa AD. First Report of Candidatus Mycoplasma haemohominis Infection in Australia Causing Persistent Fever in an Animal Carer. Clin Infect Dis 2021; 72:634-640. [PMID: 32006025 DOI: 10.1093/cid/ciaa089] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/30/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Hemotropic mycoplasmas (hemoplasmas) infect animals and humans and can lead to clinical syndromes mainly characterized by hemolytic anemia. A novel pathogen, Candidatus Mycoplasma haemohominis, was recently associated with a case of human hemoplasmosis in Europe. Here we report the first detection of this pathogen in an Australian patient exhibiting persistent fever, hemolytic anemia, and pancytopenia over a 10-month period. METHODS After exhaustive negative testing for human infectious diseases, whole genome sequencing (WGS) was performed on the patient's bone marrow aspirate, using an Illumina NextSeq500 platform. Conventional polymerase chain reaction (PCR), followed by Sanger sequencing, was then performed on blood samples using novel Mycoplasma-specific primers targeting the 16S ribosomal RNA gene. In addition, a Mycoplasma-specific fluorescence in situ hybridization (FISH) assay was developed to differentiate Mycoplasma cells from other erythrocyte inclusions (eg, Pappenheimer and Howell-Jolly bodies) which are morphologically similar to bacterial cocci by light microscopy. RESULTS WGS analysis revealed that approximately 0.04% of the total number of unmapped reads to human genome corresponded to Mycoplasma species. A 1-kb Mycoplasma 16S fragment was successfully amplified by conventional PCR, and sequence analyses revealed 100% identity with Candidatus Mycoplasma haemohominis. FISH confirmed that several (approximately 2%) epierythrocytic inclusions initially observed by light microscopy corresponded to Mycoplasma cells. CONCLUSIONS This represents the second report of hemolytic anemia associated with hemoplasma infection in a human, and the first report of human hemoplasmosis in Australia. This study highlights the importance of new and emerging diagnostic approaches and need for further investigations on the epidemiology of Candidatus Mycoplasma haemohominis in Australia.
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Affiliation(s)
- Kylie Alcorn
- Department of Immunology and Infectious Diseases, Gold Coast Health Service, Gold Coast, Australia
| | - John Gerrard
- Department of Immunology and Infectious Diseases, Gold Coast Health Service, Gold Coast, Australia
| | - Tara Cochrane
- Department of Haematology, Gold Coast University Hospital and Griffiths University, Gold Coast, Australia
| | - Rikki Graham
- Public Health Microbiology, Forensic and Scientific Services, Queensland Department of Health, Brisbane, Australia
| | - Amy Jennison
- Public Health Microbiology, Forensic and Scientific Services, Queensland Department of Health, Brisbane, Australia
| | - Peter J Irwin
- Vector- and Water-Borne Pathogens Research Group, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
| | - Amanda D Barbosa
- Vector- and Water-Borne Pathogens Research Group, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia.,CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil
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17
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Abstract
Tuberculosis is an established cause of pyrexia of unknown origin and can implicate practically any human organ system. Splenic involvement is common in disseminated or miliary tuberculosis following hematogenous spread, but isolated splenic involvement is a very rare phenomenon. We report the case of a 30-year-old immunocompetent female who presented with high-grade fever and dull aching pain in the left hypochondrium for three months. Laboratory data provided no diagnostic information. Abdominal ultrasonography revealed an enlarged spleen with multiple small hypoechoic lesions that were corroborated on computed tomography. No pulmonary involvement or primary focus of infection was discernible elsewhere. Splenic fine needle aspiration cytology helped clinch a histopathological diagnosis of isolated splenic tuberculosis. Administration of anti-tubercular therapy resulted in resolution of the disease and an excellent outcome in our patient.
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Affiliation(s)
- Sahil Grover
- Internal Medicine, Government Medical College & Hospital, Chandigarh, IND
| | - Yajur Arya
- Internal Medicine, Government Medical College & Hospital, Chandigarh, IND
| | - Saurabh Gaba
- Internal Medicine, Government Medical College & Hospital, Chandigarh, IND
| | - Monica Gupta
- Internal Medicine, Government Medical College & Hospital, Chandigarh, IND
| | - Arshi Syal
- Internal Medicine, Government Medical College & Hospital, Chandigarh, IND
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18
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Rana A, Kotton CN, Mahapatra A, Nandwani A, Sethi S, Bansal SB. Post kidney transplant histoplasmosis: An under-recognized diagnosis in India. Transpl Infect Dis 2020; 23:e13523. [PMID: 33222373 DOI: 10.1111/tid.13523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/04/2020] [Accepted: 11/01/2020] [Indexed: 11/27/2022]
Abstract
Histoplasmosis is an invasive mycosis caused by fungus Histoplasma capsulatum. Clinical features of histoplasmosis are often nonspecific, but patients with disseminated infection may present with severe manifestations posing an increasing threat to patients with various immunocompromised conditions. It is often misdiagnosed as tuberculosis in endemic regions leading to high mortality. There is under-reporting of histoplasmosis in solid organ transplant from India undermining its actual incidence and impact. As a result of the potentially fatal nature of the disease, careful evaluation with tissue diagnosis is recommended. We present a series of five cases of disseminated histoplasmosis in renal transplant recipients from our centre, highlighting its significance as differential diagnosis in this population. To our knowledge, this is the largest case series reported from India in renal transplant patients.
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Affiliation(s)
- Abhyudaysingh Rana
- Department of Nephrology and Renal Transplant Medicine, Medanta - The Medicity, Gurguram, Haryana, India
| | - Camille N Kotton
- Transplant and Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amit Mahapatra
- Department of Nephrology and Renal Transplant Medicine, Medanta - The Medicity, Gurguram, Haryana, India
| | - Ashish Nandwani
- Department of Nephrology and Renal Transplant Medicine, Medanta - The Medicity, Gurguram, Haryana, India
| | - Sidharth Sethi
- Department of Nephrology and Renal Transplant Medicine, Medanta - The Medicity, Gurguram, Haryana, India
| | - Shyam B Bansal
- Department of Nephrology and Renal Transplant Medicine, Medanta - The Medicity, Gurguram, Haryana, India
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19
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Crawshaw H, Rachakonda KS, Kim L, Enno A, Jegatheesan T. Intensive care management of a rare case of pyrexia of unknown origin (Kikuchi-Fujimoto disease). Anaesth Intensive Care 2020; 48:318-323. [PMID: 32731741 DOI: 10.1177/0310057x20937314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Kikuchi-Fujimoto disease is a rare, benign cause of necrotising lymphadenitis often presenting with fever. We describe a case of a 17-year-old boy with non-verbal autism presenting to our intensive care unit with prolonged fever of unknown cause. This case highlights the role of the intensive care unit in cases of diagnostic dilemma. The critical care community should be aware of Kikuchi-Fujimoto disease as although it is usually benign, it can rarely lead to acute airway compromise.
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Affiliation(s)
- Helena Crawshaw
- Department of General and Acute Care Medicine, Liverpool Hospital, Sydney, Australia
| | - Kanaka S Rachakonda
- Department of Intensive Care Medicine, Liverpool Hospital, Sydney, Australia
| | - Leah Kim
- Department of Intensive Care Medicine, Liverpool Hospital, Sydney, Australia
| | - Alar Enno
- Department of Anatomical Pathology, Liverpool Hospital, Sydney, Australia
| | - Thulasi Jegatheesan
- Department of General and Acute Care Medicine, Liverpool Hospital, Sydney, Australia
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20
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Headlam J, Wheeler A, Yuen K, Brierley E, Todd OM. Disseminated bacillus Calmette-Guérin (BCG): a cause of delirium in an older adult. J R Coll Physicians Edinb 2020; 50:152-155. [PMID: 32568287 DOI: 10.4997/jrcpe.2020.215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Intra-vesical Bacillus Calmette-Guérin (BCG) immunotherapy is an effective treatment for high-risk bladder cancer. Less well known is that fewer than 1% of patients receiving BCG treatment can develop disseminated BCG. The reaction can range from a mild flu-like illness to a systemic disorder with a fulminant course which in the most severe cases can lead to death. The diagnostic yield is low and diagnosis is often made after a comprehensive exclusion of more common causes of pyrexia of unknown origin. A high level of suspicion is therefore required in those who may be at risk. We report a case of disseminated BCG in an older patient for whom early involvement of his family was pertinent to determining the precipitant for delirium.
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Affiliation(s)
- John Headlam
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Alice Wheeler
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Keith Yuen
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Oliver M Todd
- Academic Unit for Ageing and Stroke Research University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust Bradford BD9 6RJ, UK,
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21
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Wright WF, Auwaerter PG. Fever and Fever of Unknown Origin: Review, Recent Advances, and Lingering Dogma. Open Forum Infect Dis 2020; 7:ofaa132. [PMID: 32462043 PMCID: PMC7237822 DOI: 10.1093/ofid/ofaa132] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/15/2020] [Indexed: 12/11/2022] Open
Abstract
Fever has preoccupied physicians since the earliest days of clinical medicine. It has been the subject of scrutiny in recent decades. Historical convention has mostly determined that 37.0°C (98.6°F) should be regarded as normal body temperature, and more modern evidence suggests that fever is a complex physiological response involving the innate immune system and should not be characterized merely as a temperature above this threshold. Fever of unknown origin (FUO) was first defined in 1961 by Petersdorf and Beeson and continues to be a clinical challenge for physicians. Although clinicians may have some understanding of the history of clinical thermometry, how average body temperatures were established, thermoregulation, and pathophysiology of fever, new concepts are emerging. While FUO subgroups and etiologic classifications have remained unchanged since 1991 revisions, the spectrum of diseases, clinical approach to diagnosis, and management are changing. This review considers how newer data should influence both definitions and lingering dogmatic principles. Despite recent advances and newer imaging techniques such as 18-fluorodeoxyglucose-positron emission tomography, clinical judgment remains an essential component of care.
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Affiliation(s)
- William F Wright
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine Baltimore, Maryland, USA
| | - Paul G Auwaerter
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine Baltimore, Maryland, USA
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Arora N, Shukla S, Vijaykumar D, Suri V, Kumar R, Pannu AK. Pyrexia of unknown origin in HIV-negative adults from Himachal Pradesh (India): will you suspect disseminated histoplasmosis? Trop Doct 2020; 50:275-277. [PMID: 32098613 DOI: 10.1177/0049475520908725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Histoplasmosis is usually clinically suspected only in people who reside in, are migrants from or are travelling to endemic areas such as North America. Immunocompetent patients with a low level of exposure typically have either subclinical or mild and self-limiting infection. The most common risk for the development of progressive disseminated form is HIV infection. We recently managed two patients with disseminated histoplasmosis, presenting with prolonged fever, significant weight loss, pallor and hepatosplenomegaly. Both were HIV-negative and lived in Himachal Pradesh (India), a region that was considered "Histoplasma-free" until recently.
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Affiliation(s)
- Navneet Arora
- Senior Resident, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubham Shukla
- Resident, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Vijaykumar
- Resident, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Additional Professor, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Kumar
- Assistant Professor, Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok K Pannu
- Assistant Professor, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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23
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Khan IS, Kuick CH, Jain S, Wen Quan Lian D, Hong Pheng Loh A, Tan AM, Tou-En Chang K. Primary Adrenal Angiomatoid Fibrous Histiocytoma With Novel EWSR1-ATF1 Gene Fusion Exon-Exon Breakpoint. Pediatr Dev Pathol 2019; 22:472-474. [PMID: 30823861 DOI: 10.1177/1093526619830287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe the clinical, pathological, and molecular features of a primary adrenal angiomatoid fibrous histiocytoma (AFH) in an 11-year-old girl presenting with pyrexia of unknown origin. We performed next-generation sequencing-based anchored multiplex polymerase chain reaction (Archer® FusionPlex® sarcoma assay), which revealed an EWSR1-ATF1 gene fusion with novel breakpoints in exon 11 of EWSR1 and exon 3 of ATF1. The pyrexia resolved fully after surgical resection, and the patient was disease-free on follow-up at 1 year and 6 months. This case exemplifies the value of molecular testing of pediatric neoplasms presenting at unusual sites for diagnosis and identification of novel gene fusion breakpoints.
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Affiliation(s)
- Irfan Sagir Khan
- Department of Pathology, National University Health System, Singapore, Republic of Singapore
| | - Chik Hong Kuick
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Republic of Singapore
| | - Sudhanshi Jain
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Republic of Singapore
| | - Derrick Wen Quan Lian
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Republic of Singapore
- Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Amos Hong Pheng Loh
- Duke-NUS Medical School, Singapore, Republic of Singapore
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore, Republic of Singapore
| | - Ah Moy Tan
- Duke-NUS Medical School, Singapore, Republic of Singapore
- Hematology-Oncology Service, KK Women's and Children's Hospital, Singapore, Republic of Singapore
| | - Kenneth Tou-En Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Republic of Singapore
- Duke-NUS Medical School, Singapore, Republic of Singapore
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24
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Bansal Y, Aggarwal A, Gadepalli R, Nag VL. Seroprevalence of brucellosis in Western Rajasthan: A study from a tertiary care centre. Indian J Med Microbiol 2019; 37:426-432. [PMID: 32003345 DOI: 10.4103/ijmm.ijmm_19_358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Brucellosis is a significant bacterial zoonotic disease with a high seroprevalence in low-to-middle-income countries where there is a significant contact of humans with animals. This prospective study was conducted to observe the seroprevalence of brucellosis in 75 symptomatic patients with pyrexia of unknown origin (PUO) and 75 high-risk individuals (10 veterinarians, 15 milkmen and 50 healthy contacts of symptomatic patients) with possible exposure to brucellosis. Serum samples collected from these patients and individuals were subjected to rose Bengal test (RBT) and ELISA for the detection of IgM and IgG antibodies. RBT was positive in 50 samples (40 PUO and 10 high risk), of which 25 (33.3%) PUO cases had detectable IgM antibodies, whereas IgG antibodies were detected in 20 patients. None of samples from high-risk individuals was reactive for IgM/IgG antibodies by ELISA. The overall seroprevalence in this study was 16.7% (33.3% in PUO patients). Being a predominantly livestock rearing area, brucellosis is a significant health-care problem in this part of India with this entity being linked to 33% of PUO cases.
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Affiliation(s)
- Yashik Bansal
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Alisha Aggarwal
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravisekhar Gadepalli
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vijaya Lakshmi Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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25
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Rizvi M, Sultan A, Chowdhry M, Azam M, Khan F, Shukla I, Khan HM. Prevalence of scrub typhus in pyrexia of unknown origin and assessment of interleukin-8, tumor necrosis factor-alpha, and interferon-gamma levels in scrub typhus-positive patients. INDIAN J PATHOL MICR 2018; 61:76-80. [PMID: 29567888 DOI: 10.4103/ijpm.ijpm_644_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Scrub typhus is lesser known cause of fever of unknown origin in India. Even if there have been reports documenting the prevalence of scrub typhus in different parts of India, it is still an unknown entity, and clinicians usually do not consider it as differential diagnosis. The present study was performed to document the prevalence of scrub typhus among febrile patients in western part of Uttar Pradesh and to assess the clinical profile of infected patients on the one hand and knowledge, attitude, and practices among clinicians on the other. Materials and Methods A total of 357 adult patients with fever of more than 5-day duration were recruited. All patients underwent complete physical examination, and detailed clinical history was elicited as per predesigned pro forma. After primary screening to rule out malaria, enteric fever, and leptospirosis infection, secondary screening for scrub typhus was done by rapid screen test and IgM ELISA. Results Scrub typhus infection was positive in 91 (25.5%) cases. The most common symptoms among the patients were fever (100%), pain in abdomen (79.1%), pedal edema 56 (61.5%), rash 44 (48.3%), headache 44 (48.3%), vomiting 42 (46.1%), constipation 33 (36.2%), cough 28 (30.7%), and lymphadenopathy 20 (21.9%). The median values of interleukin-8, interferon-gamma, and tumor necrosis factor-alpha in healthy controls were 15.54 pg/ml, 7.77 pg/ml, and 54.1 pg/ml, respectively, while the median values of these cytokines in scrub typhus-positive patients were 21.04 pg/ml, 8.74 pg/ml, and 73.8 pg/ml, respectively. Conclusion Our results highlight that scrub typhus infection is an important cause of pyrexia of unknown origin, and active surveillance is necessary to assess the exact magnitude and distribution of the disease.
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Affiliation(s)
- Meher Rizvi
- Department of Microbiology, J. N. Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Asfia Sultan
- Department of Microbiology, J. N. Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Madhav Chowdhry
- Department of Microbiology, J. N. Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohd Azam
- Department of Microbiology, J. N. Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Fatima Khan
- Department of Microbiology, J. N. Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Indu Shukla
- Department of Microbiology, J. N. Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Haris M Khan
- Department of Microbiology, J. N. Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Chaudhry R, Kokkayil P, Ghosh A, Bahadur T, Kant K, Sagar T, Kabra SK, Lodha R, Dey AB, Menon V. Bartonella henselae infection in diverse clinical conditions in a tertiary care hospital in north India. Indian J Med Res 2018; 147:189-194. [PMID: 29806608 PMCID: PMC5991118 DOI: 10.4103/ijmr.ijmr_1932_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background & objectives: Bartonella henselae causes infections which closely resemble febrile illness and chronic diseases such as tuberculosis and haematological malignancies. There are not many studies on Bartonella infections from India. The present study was undertaken to diagnose B. henselae infection in diverse clinical conditions in a tertiary care hospital in north India. Methods: A total of 145 patients including those with fever and lymphadenopathy, infective endocarditis and neuroretinitis were enrolled in the study. Whole blood, serum and lymph node aspirate and valvular vegetations if available, were obtained. Samples were plated on chocolate agar and brain-heart infusion agar containing five per cent fresh rabbit blood and were incubated at 35°C for at least four weeks in five per cent CO2 with high humidity. Immunofluorescent antibody assay (IFA) was done for the detection of IgM antibodies in the serum using a commercial kit. Whole blood was used to perform polymerase chain reaction (PCR) for the citrate synthase gene (gltA). Results: IFA was positive in 11 of 140 (7.85%) patients and PCR was positive in 3 of 140 (2.14%) patients. Culture was negative in all the cases. A higher incidence of Bartonella infection was seen in patients with fever and lymphadenopathy (n=30), seven of whom were children. In ophthalmological conditions, four cases were IFA positive. Interpretation & conclusions: The present study shows that the threat of Bartonella infection is a reality in India. It is also an important treatable cause of fever and lymphadenopathy in children. Serology and PCR are useful tests for its diagnosis. Clinicians should consider Bartonella infection in the differential diagnosis of febrile illnesses and chronic diseases.
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Affiliation(s)
- Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Arnab Ghosh
- Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Tej Bahadur
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamala Kant
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Tanu Sagar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar Kabra
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Aparajit Ballav Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vimala Menon
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Adult-onset Still's disease is a systemic autoinflammatory disease the presentation of which can often mimic infection. As a consequence, there is often a delay in diagnosis. Serositis is a recognised but less common clinical feature that can result in complications including cardiac tamponade and constrictive pericarditis. We describe a case of adult-onset Still's disease without the hallmark rash or significant arthritis, presenting with polyserositis that showed a good response to initial steroid treatment and sustained remission with anakinra. An elevated procalcitonin level was due to active adult-onset Still's disease, not bacterial infection.
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Affiliation(s)
- Ali Sibtain Farooq Sheikh
- 1 Rheumatology Registrar, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, UK
| | - Jonathan Marks
- 2 Consultant Rheumatologist, The Royal Bournemouth & Christchurch Hospitals, UK
| | - Neil Hopkinson
- 2 Consultant Rheumatologist, The Royal Bournemouth & Christchurch Hospitals, UK
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28
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Abstract
The syndrome of pyrexia of unknown origin (PUO) was first defined in 1961 but remains a clinical challenge for many physicians. Different subgroups with PUO have been suggested, each requiring different investigative strategies: classical, nosocomial, neutropenic and HIV-related. This could be expanded to include the elderly as a fifth group. The causes are broadly divided into four groups: infective, inflammatory, neoplastic and miscellaneous. Increasing early use of positron emission tomography-computed tomography (PET-CT) and the development of new molecular and serological tests for infection have improved diagnostic capability, but up to 50% of patients still have no cause found despite adequate investigations. Reassuringly, the cohort of undiagnosed patients has a good prognosis. In this article we review the possible aetiologies of PUO and present a systematic clinical approach to investigation and management of patients, recommending potential second-line investigations when the aetiology is unclear.
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Affiliation(s)
- Cristina Fernandez
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Nick J Beeching
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital and Clinical Sciences Group, Liverpool School of Tropical Medicine, Liverpool, UK
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29
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Sulaiman W, Abdullah AC, Tan Tsen Chuen J, Baba S, Karim N. Refractory Adult Onset Still's Disease. Cureus 2017; 9:e1802. [PMID: 29282446 PMCID: PMC5741270 DOI: 10.7759/cureus.1802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
It is often a challenge and a dilemma for clinicians encountering patients with pyrexia of unknown origin. Numerous tests performed to determine the underlying cause often give inconclusive results. We present a 52-year-old man with undulating fever for more than 10 months with persistent hyperferritinaemia, and negative immunological and serological markers. Despite corticosteroids, disease modifying anti-rheumatic agents and immune-modulator therapy, he succumbed to the illness. A diagnosis of refractory Adult onset Still’s disease complicated by haemophagocytic lymphohistiocytosis was made.
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Affiliation(s)
- Wahinuddin Sulaiman
- Medicine, Faculty of Medicine, Universiti Kuala Lumpur Royal College of Medicine Perak
| | | | | | - Shaffie Baba
- Radiology, Hospital Raja Permaisuri Bainun, Ipoh
| | - Norain Karim
- Pathology, Hospital Raja Permaisuri Bainun, Ipoh
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Beresford RW, Gosbell IB. Pyrexia of unknown origin: causes, investigation and management. Intern Med J 2017; 46:1011-6. [PMID: 27633467 DOI: 10.1111/imj.13180] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/01/2016] [Accepted: 01/10/2016] [Indexed: 11/30/2022]
Abstract
Pyrexia of unknown origin (PUO) is a syndrome that has long tested the skills of physicians to achieve a diagnosis in affected patients. By definition, patients included in this syndrome will be more difficult to diagnose as they have already resisted classification during baseline investigations. Furthermore, investigation of PUO requires knowledge of many diseases across a range of clinical specialties, as well as knowledge of less commonly used investigative tools. As both society and medicine continue to change, the aetiology and epidemiology of the diseases that cause PUO also change. For these reasons, it is important for physicians to approach PUO in a logical manner, and for the causes and approach to PUO to be continuously reviewed. In this article, we review the aetiology of PUO and the diagnostic strategies that may be used to investigate it.
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Affiliation(s)
- R W Beresford
- Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service, New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - I B Gosbell
- Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service, New South Wales Health Pathology, Sydney, New South Wales, Australia. .,Molecular Medicine Research Group, School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia. .,Antibiotic Resistance and Mobile Elements Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.
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Mirgh SP, Shah VD, Sorabjee JS. A Microbial Old Friend with a New Face: A Rare Case of Pyrexia of Unknown Origin and Leukemoid Reaction. J Glob Infect Dis 2017; 9:117-119. [PMID: 28878524 PMCID: PMC5572196 DOI: 10.4103/jgid.jgid_166_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a young male, who presented to us with high-grade fever for more than four weeks, refractory seizures, multiple subcutaneous palpable lumps, and evidence of leukocytosis with predominant left shift on the peripheral smear. The classic "starry-sky" appearance on imaging, generalized muscular uptake on positron emission tomography-computerized tomography scan, and positive serology led to a diagnosis of disseminated cysticercosis. He responded to oral steroids. To the best of our knowledge, disseminated cysticercosis presenting as pyrexia of unknown origin and with a leukemoid reaction has never been reported in literature.
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Affiliation(s)
- Sumeet P Mirgh
- Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Virti D Shah
- Department of Neurology, Sir Ganga Ram Hospital, New Delhi, India
| | - Jehangir S Sorabjee
- Department of Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
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Varma R, Campbell G, Baxendale H. Lesson of the month 1: Autoinflammatory syndromes - an unusual cause of pyrexia of unknown origin. Clin Med (Lond) 2016; 16:488-490. [PMID: 27697817 PMCID: PMC6297307 DOI: 10.7861/clinmedicine.16-5-488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Autoinflammatory diseases are disorders of innate immunity and are characterised by recurring and unprovoked episodes of inflammation. We present a case of episodic pyrexia, associated with a significant inflammatory response, in a young man in whom the cause had remained unexplained since infancy. He was eventually diagnosed with hyperimmunoglobulinaemia D syndrome (HIDS); one of the autoinflammatory syndromes.
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Affiliation(s)
- Ravi Varma
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Gary Campbell
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
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Prajapati R, Kumar A, Sharma P, Singla V, Bansal N, Dhawan S, Arora A. A Rare Presentation of Leishmaniasis. J Clin Exp Hepatol 2016; 6:146-8. [PMID: 27493461 PMCID: PMC4963322 DOI: 10.1016/j.jceh.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 01/06/2016] [Indexed: 12/12/2022] Open
Abstract
Leishmaniasis or kala-azar is a protozoan disease that can present as cutaneous, mucocutaneous, visceral, and disseminated disease. In India, it is usually localized in distinct areas of Bihar, Jharkhand, West Bengal, and parts of Eastern Uttar Pradesh. Visceral leishmaniasis (VL) involves the visceral organs, mainly the liver, the spleen and bone marrow. VL is characterized by prolonged fever, massive splenomegaly, weight loss, progressive anemia, pancytopenia, and hypergammaglobulinemia, and can be complicated by serious infections. In most of the patient the diagnosis is made on bone marrow biopsy or splenic aspirate. We hereby present an unusual case of kala-azar in a 52-year-old patient non-resident of endemic area presenting with pyrexia of unknown origin, in whom bone marrow biopsy was negative for Leishmanin Donovan (LD) bodies, and diagnosis was made by liver biopsy in which LD bodies were seen.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- ANA, anti-nuclear antibodies
- AST, aspartate aminotransferase
- CT, computerized tomography
- E, eosinophils
- ESR, erythrocyte sedimentation rate
- GGT, gamma glutamyl transferase
- HBsAg, hepatitis B surface antigen
- HCV, hepatitis C virus
- HIV, human immunodeficiency virus
- L, lymphocytes
- LD, Leishmanin Donovan
- Leishmanin Donovan bodies
- P, polymorphs
- PET, positron emission tomography
- PUO, pyrexia of unknown origin
- VL, visceral leishmaniasis
- WBC, white blood count
- kala-azar
- protozoan disease
- pyrexia of unknown origin
- visceral leishmaniasis
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Affiliation(s)
- Ritesh Prajapati
- Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Kumar
- Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India,Address for correspondence: Dr. Ashish Kumar, Associate Professor, Department of Gastroenterology & Hepatology, Ganga Ram Institute of Postgraduate Medical Education & Research (GRIPMER), Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110 060, India. Tel.: +91 9312792573; fax: +91 11 25861002.
| | - Praveen Sharma
- Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Vikas Singla
- Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Naresh Bansal
- Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Shashi Dhawan
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Arora
- Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India
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Abstract
Pyrexia of unknown origin (PUO) in a patient with acquired immunodeficiency syndrome (AIDS) is a challenging clinical problem despite recent advances in the diagnostic modalities. The diagnosis of the cause of fever is especially difficult in the postoperative period as the focus remains on the operative site. We present an unusual cause of PUO in a patient with advanced HIV disease during an immediate postoperative period following total hip arthroplasty (THA) for osteoarthritis (OA) of the left hip. The fever started on the eighth postoperative day, and after an extensive workup to rule out infection it was found that the patient was allergic to sulfa drugs. The fever subsided after discontinuation of trimethoprim/sulfamethoxazole. Fever in an immunocompromised patient should not be attributed only to infection. A high index of suspicion along with careful history making is required to diagnose drug fever. An early diagnosis of drug fever can reduce hospital stay and the costs of investigations and treatment.
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Singh N, Kumar R, Malhotra A, Bhalla AS, Kumar U, Sood R. Diagnostic utility of fluorodeoxyglucose positron emission tomography/computed tomography in pyrexia of unknown origin. Indian J Nucl Med 2015; 30:204-12. [PMID: 26170562 PMCID: PMC4479908 DOI: 10.4103/0972-3919.158528] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose of the Study: The present study was undertaken to evaluate the diagnostic utility of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) in patients presenting as pyrexia of unknown origin (PUO). Materials and Methods: Forty-seven patients (31 males and 16 females; mean age of 42.7 ± 19.96 years) presenting as PUO to the Department of Medicine at the All India Institute of Medical Sciences, New Delhi over a period of 2 years underwent F-18 FDG PET/CT. PET ⁄ CT was considered supportive when its results correlated with the final definitive diagnosis. Final diagnosis was made on the basis of combined evaluation of history, clinical findings, investigations, and response to treatment. Results: Thirty-five PET/CT studies (74.5%) were positive. However, only 18 (38.3%) were supportive of the final diagnosis. In three patients (6.4%), PET/CT was considered diagnostic as none of the other investigations including contrast-enhanced computed tomography of chest and abdomen, and directed tissue sampling could lead to the final diagnosis. All these three patients were diagnosed as aortoarteritis. Conclusion: Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography is an important emerging modality in the workup of PUO. It supported the final diagnosis in 38% of our patients and was diagnostic in 6.4% of patients. Thus, PET/CT should only be considered as second-line investigation for the diagnostic evaluation of PUO; especially in suspected noninfectious inflammatory disorders.
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Affiliation(s)
- Nidhi Singh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Malhotra
- Department of Nuclear Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Uma Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rita Sood
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Ranjan P, Kumar V, Ganguly S, Vyas S, Yadav R, Sood R. Isolated native Tricuspid Valve Endocarditis Presenting as PUO in a Young Adult Male Without Any Risk Factors. J Family Med Prim Care 2015; 4:139-41. [PMID: 25811008 PMCID: PMC4366989 DOI: 10.4103/2249-4863.152274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 28-year-old male presented to our hospital with high-grade fever and weight loss for 4 months. Clinical examination was non-contributory and there was no history of any high-risk behavior or prolonged skin or dental infections. Native tricuspid-valve endocarditis may rarely present in these settings and high index of suspicion is essential for early diagnosis.
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Affiliation(s)
- Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Kumar
- Department of Medical Intern, All India Institute of Medical Sciences, New Delhi, India
| | - Shuvadeep Ganguly
- Department of Medical Intern, All India Institute of Medical Sciences, New Delhi, India
| | - Surabhi Vyas
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Yadav
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rita Sood
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Siddiqui B, Rabindranath D, Faridi SH, Khan AA, Haiyat S, Eswaran R. Megaloblastic anemia: A common but often neglected cause of pyrexia of unknown origin. J Transl Int Med 2015; 3:64-67. [PMID: 27847889 PMCID: PMC4936446 DOI: 10.1515/jtim-2015-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective The objective was to study megaloblastic anemia as a cause of pyrexia of unknown origin (PUO). Materials and Methods We conducted a study on 15 patients of megaloblastic anemia associated with fever, attending our hospital clinics over a period of 6 months. Results While 11 patients had symptoms suggesting foci of infection and responded well to intravenous antibiotics, 4 patients had neither any evidence of infection nor responded with empirical broad spectrum antibiotic treatment. They were treated with vitamin B12/folate therapy which led to marked improvement in fever within 48 h. Presenting complaints of the patients and severity/duration of fever along with other epidemiological data were also studied in each case. Conclusion The present study led us to conclude that megaloblastic anemia forms an important and reversible cause of fever and should be ruled out in all patients presenting with PUO. This knowledge would help the physicians in adequate and timely management of these patients.
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Affiliation(s)
- Bushra Siddiqui
- Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Divya Rabindranath
- Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Shahbaz Habib Faridi
- Department of Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Azka Anees Khan
- Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Sadaf Haiyat
- Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Rabindranath Eswaran
- Department of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Yu HY, Sheng JF. Liver tuberculosis presenting as an uncommon cause of pyrexia of unknown origin: positron emission tomography/computed tomography identifies the correct site for biopsy. Med Princ Pract 2014; 23:577-9. [PMID: 24434500 PMCID: PMC5586922 DOI: 10.1159/000357869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 12/09/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To identify the correct site to biopsy in a case of pyrexia of unknown origin (PUO) caused by hepatic tuberculosis (TB). CLINICAL PRESENTATION AND INTERVENTION A 58-year-old man who developed hepatic TB presented with PUO. Ultrasonography (US) and computed tomography (CT) of the abdomen showed only calcifications in the liver, and positron emission tomography (PET)/CT showed diffuse increased metabolic activity in addition to focal areas of increased activity. A diagnosis of hepatic TB was confirmed by histological examination of liver tissues and interferon-γ release assays (IGRAs of T-SPOT/TB). The patient was treated with 4 anti-tubercular therapies (rifampicin, isoniazid, ethambutol and pyrazinamide). At the 3-month follow-up, the patient was disease free as confirmed by abdominal US. CONCLUSION PET/CT was helpful in identifying a site to biopsy that led to the correct diagnosis.
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Affiliation(s)
- Hai-Ying Yu
- State Key Laboratory of Infectious Diseases and Department of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
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Abstract
Brucellosis is a chronic infection produced by members of the Brucella family. Diagnosis of this condition requires either isolation of the organism in culture or positive serological tests.We describe a 27-year-old male admitted as a case of pyrexia of unknown origin (PUO), who tested negative for Brucella IgM ELISA test on preliminary evaluation but was subsequently diagnosed on the strength of positive blood and bone marrow cultures to be a case of brucellosis secondary to Brucella suis infection. In addition to highlighting the pathogenic potential of an unusual organism, this case demonstrates the unreliability of standard serological tests based on the Brucella melitensis antigen for infection with other species of Brucella.
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Affiliation(s)
- Kushal Naha
- Department of Medicine, Kasturba Medical College, Manipal University, Manipal
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