Pyrexia of Unknown Origin | Figure 1

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Pyrexia of Unknown Origin

25 year old lady, postpartum NVD 45 days presented with 5 day history of fever. She took antibiotics by a local doctor and developed a rash on abdomen. She was later admitted to another hospital where she received anti malarial and later she developed tonic clonic seizures. She was later referred to us. The pregnancy was 9 months and 10 days and baby was delivered by normal vaginal delivery with no intra or immediate postpartum complications. During the last trimester of pregnancy, the patient had pruritic papular rash mostly on face and upper extremities which responded to oral antihistamines.

With us her extensive work up was done which is mentioned later. She was started on antibiotics and other symptomatic medications.

Her labs showed anemia, high TLC, deranged LFTs.

She was treated as a case of Hep E but the patient is still spiking high grade fever and consistently her Hb is coming low and TLC is running above 20k despite being on Vanc and meropenem.

Need suggestions

35 year old man

Drug history during last 40 days:

O/E:

Labs:

CT report: prominent gall bladder wall with cholecystic fluid, splenomegaly, ascites, minimal pleural effusions/reactions and changes in bilateral kidneys representing mild infective/inflammatory changes. Ultrasound normal. Ferritin more than 2000 (acute phase reactant though) Retic count 2%. He is currently on Meropenem and still having high grade fever. A bone marrow is in plan now. Your thoughts?

A 40 years old female is 32nd weeks pregnant. Gravid 3rd Para 1 Abortion 2. She had SOBE, Orthopnea, Chest tightness for 1 months. Recently she can't lay down due to severe breathlessness. Then she was admitted to nearby hospital. After admission Hb% 7.3 gm/dl then she was given IV Iron Sucrose later her condition worsened. Later she was transfused 1 unit of Packed Cell. After transfusion her Hb% 6.7 gm/dl, S. Albumin 2.9 gm, Echocardiography Mild Pulmonary Hypertension with LVEF 60%, Hb Electrophoresis Normal, S. Ferritin 547. Then 2nd unit of Blood Transfusion given and after 1 day later she had very high-grade fever and basal creps. She developed Ana sarca. Her condition getting worse. JAK2 Mutation Assay is sent, Vitamin B12 and Folic Acid level sent, Urine for Bence Jones Protein and Urine C/S sent. What is the next plan to save mother and baby?

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:

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.

34yrs/M admitted with C/o Generalized bodyaches, 3-day history of on and off fever which is temporarily relieved by paracetamol, Hypogastric pain. He also experienced nausea and vomiting with loss of appetite. No petechiae or rashes present over body. He was tested negative for COVID 19 but positive for dengue. On day 2 admission patient developed dry cough and mild difficulty in breathing.

Need Suggestions?

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family. Are there any features in this ECG that would warrant further work-up or is this just a pediatric ECG?