%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)

Pyrexia of unknown Origin

This 33 year old gentleman with previous no morbidities was presented with the chief complaint of high grade continuous fever for the last 20 days. He was initially diagnosed with malaria falciparum 2 weeks back and received anti malarials. His fever did not settle and he took ciprofloxacin along with a few other antibiotics and anti malarial again. He was presented to us yesterday with 104 fever which is continuous. Examination is unremarkable. No lymph nodes no rash no visceromegaly.

These are his labs:

Peripheral Smear pancytopenia

• Hb 8.9 g/dl
• TLC 2.28
• Platelet 45
• MCV 88
• Anisocytosis
• RDW 13.5
• MP dengue negative

His creatinine is 4 and GFR is 17.8

LFTs shows total bili 0.95

• ALT 119
• Albumin 3.04

Hepatitis B C HIV negative

Urine r/e shows 3 red cells and ++ albuminuria

LDH is markedly raised 3599

Calcium 8

Uric acid 9

Ultrasound shows only mild splenomegaly.

PT APTT is normal.

As peripheral smear looks normal, bone marrow biopsy won't show much. It'll only show peripheral destruction and that's due to spleen.

Any views or suggestions?

Thank you..