86

CASE 86


A 38-year-old man developed a flu-like syndrome with fever, headache, and anorexia. During the ensuing 8 weeks, he noted continuing fevers, sweats, 30-lb weight loss, and depression. He saw his family physician, complaining of acute pain in joints, especially his lower back.


He was a computer programmer and had recently traveled to Crete to visit his grandmother. During his stay on the Mediterranean island he enjoyed drinking unpasteurized goat milk. Six weeks after his return to the United States he developed the current illness.



PHYSICAL EXAMINATION



VS: T 38.2°C, P 84/min, R 14/min, BP 124/72 mmHg

PE: Generalized lymphadenopathy and mild splenomegaly were noted. Tenderness in his sacroiliac joint was also noted.


LABORATORY STUDIES



Blood



Hematocrit: 34%

Hemoglobin: 11 g/dL

WBC: 4500/μL

Differential: 62% PMNs, 21% lymphs, 12% monos

Blood gases: Normal

Serum chemistries: AST 102 U/L, ALT 94 U/L


Imaging


Plain x-rays of the lumbosacral spine were unrevealing.



Diagnostic Work-Up


Table 86-1 lists the likely causes of illness (differential diagnosis). Investigational approach may include


• Skin tests (e.g., tuberculin, histoplasmin)

• Gram and acid-fast stain of respiratory specimens, if possible

• Cultures of blood, bone marrow, other tissues (biopsy)

• Serology to measure IgG antibody

TABLE 86-1 Differential Diagnosis and Rationale for Inclusion (consideration)






Brucellosis (Brucella spp)

Dengue fever

Hepatitis A, B, or C

Histoplasmosis (Histoplasma capsulatum)

Leptospirosis (Leptospira interrogans)

Lymphoma

Subacute bacterial endocarditis

Tuberculosis (Mycobacterium tuberculosis)

Tularemia (Francisella tularensis)

Typhoid fever

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Aug 25, 2016 | Posted by in MICROBIOLOGY | Comments Off on 86

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