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Patient Case History

35 Year Old Man

• Fever: 40 days
• Cough: 40 days
• Myalgias: 20 days
• Weight Loss: Last one month.

Admitted twice before at two hospitals where his TLC was in 20k with deranged LFTs. He was on oxygen throughout the stay. Received one blood transfusion due to anemia. Denies hepatitis contact, tb or anyone sick at home. No arthralgias.

Drug History (last 40 days):

• Cefipime
• Moxiflox
• Metronidazole
• Gentamycin
• Rifamipicin
• Doxycyclin

O/E:

• Blood pressure: 100/70 mmHg
• Heart rate: 103 per min
• Temp: 103 F
• CVS: S1+S2+0
• Chest: left sided rale
• Icteric sclera and palate
• Pale conjuctiva
• No lymphadenopathy
• No rash

Labs:

• Peripheral smear:
  • Hb: 8, MCV: 55.
  • TLC: 24k neutrophilic
  • Platelet: 375
  • Creatinine: 0.63
  • ESR: 67
  • CRP: 16.4
  • ALT: 177
  • Hep B C Dengue Malaria Brucela: Negative
  • Pan cultures: Negative repeatedly
  • Urine: Normal
  • Sputum AFB and gram staining and culture: Negative

CT report: prominent gall bladder wall with cholecystic fluid, splenomegaly, ascites, minimal pleural effusions/reactions and changes in bilateral kidneys representing multi-system mild infective/inflammatory changes. Ultrasound: normal. Ferritin more than 2000 (acute phase reactant though). Retic count: 2%.

Current Treatment: Meropenem, but still having high-grade fever. A bone marrow is planned now.

Thoughts?

Additional Cases

1. 18 Year Old Male: Presented with high-grade fever for 3 weeks; blood tests are showing significant abnormalities. Further management required.

2. 4 Year Old Update: Wounds healing with medical honey scrub; need for further insights on potential conditions.

3. 80 Year Old Woman: Experiencing fever and urinary symptoms; cultures negative.

4. 25 Year Old Lady: Postpartum issues with high fever and lab results suggesting Hepatitis E; continuing management issues.

5. 52 Year Old Man: Presented with chest pain and respiratory issues; requires further comment.

6. 28-Year Old Woman: Presented with pruritus and associated skin lesions; requires further follow-up.

7. 4-Month-Old Infant: Investigating skin lesions with inflammatory signs.

8. Teen Patient Post Collapse: EKG evaluation needed for potential cardiac concerns.