Chief Complaint Of Fever Research Articles

Thrombotic thrombocytopenic purpura a new threat of a savior: A case report

Thrombotic thrombocytopenic purpura (TTP) is a potentially fatal consumptive coagulopathy that requires prompt diagnosis and treatment. It is characterized by microangiopathic hemolytic anemia and thrombocytopenia, with microthrombosis. COVID-19 vaccination is proven to reduce disease morbidity and mortality. Vaccines have been hypothesized to link to certain autoimmune diseases. We present the case of a 43-year-old man with no personal or family history of hematologic diseases who admitted with a chief complaint of fever and icterus 15 days after vaccination with the second dose of COVID_19 AstraZeneca (ChAdOx1-S). Clinical and Laboratory data (increased LDH, decreased haptoglobin, and indirect hyperbilirubinemia) was suspicious of TTP. We confirm the diagnosis of TTP With low ADAMTS13. To our knowledge, this is the first Iranian case of vaccine-induced TTP that has been reported. In conclusion, for accurate diagnosis of patients with clinical symptoms of thrombocytopenia after COVID-19 vaccination, clinicians should be alert to the possibility of acquired TTP.

LIFE CYCLE OF A COVID-19-INDUCED LUNG CYST

LIFE CYCLE OF A COVID-19-INDUCED LUNG CYST

S2533 An Unusual Finding Lurking in the Colon

Introduction: Deep Invasive gastrointestinal endometriosis (DIGIE) is rare. Out of all endometriosis cases, 7-12% of cases can have gastrointestinal involvement, ranging from single lesions, to multiple lesions, to full colonic stenosis. Symptoms can include dyspareunia, dysmenorrhea, infertility, dysphasia, diarrhea, constipation, bloating, and rectal bleeding. Here we present a patient who was incidentally found to have endometrioma. Case Description/Methods: A 24-year-old female with a past medical history significant for polycystic ovarian syndrome, HIV and endometriosis, presented to the hospital with chief complaints of fever, dysuria, hematochezia, and lower abdominal pain which had been ongoing for 3-4 days. On admission, the patient was noted to be hemodynamically stable. Abnormal laboratory results included hematocrit 32.6% (reference range 36-46%), hemoglobin 10.2 g/dL (reference range 12-16 g/dL), mean corpuscular volume 72.4 fL (reference range 80-100 fL), ferritin 15.8 ng/mL (reference range 6.3-137 ng/mL), total iron binding capacity 306 mcg/dL (reference range 265-497 mcg/dL), and iron 19 mcg/dL (reference range 37-170 mcg/dL). The following day, she underwent a colonoscopy which showed isolated diverticulosis involving the sigmoid colon. There was an active oozing diverticulum that was successfully treated with endoscopic clip placement. At the rectosigmoid junction, there was a 3 cm submucosal lesion bulging into the lumen. This appeared to have a smooth surface and was without ulceration. Biopsies were taken and the pathology showed submucosal granulation tissue with chronic inflammatory reaction and iron deposition. CD10 specific immunostains were positive, suggesting the diagnosis of an endometrioma (Figure). Discussion: This case highlights an incidental finding of DIGIE. It is important to think about colonic involvement in patients with endometriosis who have GI complaints. Rarely, these lesions can cause obstruction and may require surgery. There are currently no formal guidelines or recommendations, with most of these patients being managed on a personalized basis. Management for these patients includes symptomatic therapies, progresterones, colonic shaving, disc excision, and laparoscopic resection. As for our patient, she pursued conservative symptomatic management with close outpatient Gynecology follow up.Figure 1.: A 3 cm submucosal lesion bulging into the lumen at the rectosigmoid junction.

Adverse Cutaneous Drug Reaction Following Granulocyte Colony-Stimulating Factor Administration in Nasopharynx Cancer Patient with Febrile Neutropenia: A Case Report

Introduction: Several side effects may occur during cancer treatment such as myelosuppression following systemic chemotherapy, which is mainly manifested as neutropenia and is associated with increased infection risk. Febrile neutropenia is associated with a worse prognosis. Granulocyte colony-stimulating factor (G-CSF) may be given prophylactically before chemotherapy in selected cases or as adjuvant therapy in febrile neutropenia. G-CSF administration may be associated with several side effects, including skin manifestation. More rarely, G-CSF administration may induce acute febrile neutrophilic dermatosis is which known as a Sweet syndrome. Case Presentation: A 63-year-old man with nasopharyngeal cancer stage III on chemotherapy and radiotherapy came to our emergency department with a chief complaint of fever, coughing, and shortness of breath. He was diagnosed with community-acquired pneumonia and febrile neutropenia. His white blood cell (WBC) count was 200/mm3 . On the third day of hospitalization and G-CSF administration, he developed a rash and had skin desquamation mainly on his head including the scalp, face, lips, upper trunk, arms, and the surface of both hands. His follow-up laboratory result was WBC 8300/mm3 with a neutrophil count of 87%. Presumable Sweet syndrome diagnosis with differential diagnosis of other drug eruption reactions was made. Systemic and topical were administered, and G-CSF was stopped. Significant improvement was observed. Conclusions: G-CSF administration in febrile neutropenic cancer is generally safe; however, several adverse events may occur. Cutaneous adverse events following G-CSF administration should be recognized and treated accordingly. Sweet syndrome is rare but should be recognized as a possible G-CSF-induced drug skin complication.

Case Report On Chronic Pancreatitis In Adult

Introduction: Chronic pancreatitis is an inflammatory disease characterized by progressive destruction of the anatomy and function of the pancreas. The cells are replaced by tissue fibrosis with repeat attacks of pancreatitis. Chronic pancreatitis is an old inflammatory disease that Causes scarring of the pancreas and irreversible changes. Chronic pancreatitis causes abdominal pain and in some cases diabetes and large, bulky fatty stools. Clinical Findings: Abdominal pain, loss of appetite , vomiting , Fever .Diagnostic Evaluation : Bilirubin total : conjugated – 0.14, , blood test : RBS glucose -180, monocyte -0.2% , Granulocytes -00% , HCT -37. Ultrasonography: Pancreatic cholangiopancreatography Therapeutic Intervention : Tab .Pantaprazole 40 mg orally x OD , Tab . Lipcerna 1 tab 1,000 orally with orally TDS, Tab. Antoxipan 1 tab orally x OD , Tab .Omee 20 mg orally x OD , Syr .Aristozyme 200 ml orally x OD , Tab .Paracetamol 650 mg orally x BD . Outcome : After treatment , the patient show improvement My patient was admitted in medicine ward No -28, with AVBRH with a known case of chronic pancreatitis and he has the chief complaint of fever and pain in the abdomen . After appropriate treatment his condition are improved. Keyword : — Calculus; Diabetes; Epidemiology; India; Islets of Langerhans; Manihot; Pancreas, Exocrine; Pancreatitis, Alcoholism; Pancreatitis, Chronic; Frequency.

A rare case of appendiceal tip complete attachment to a sigmoid diverticulum: An appendiceal phlegmon case report.

IntroductionAppendiceal phlegmon is defined as an inflammatory mass, consisting of the inflamed appendix, enclosed by adjacent viscera and the greater omentum in 2 % to 10 % of patients with acute appendicitis.Case presentationA 24-year-old female presented to the hospital with chief complaints of fever, nausea, vomiting, and pain over the right lower quadrant of the abdomen for two days. In the local examination, tenderness and rebound tenderness were detected. Ultrasonography and abdominal CT scan indicated appendiceal phlegmon. After seven weeks of receiving a course of antibiotics with complete resolution of her symptoms, she underwent elective laparoscopic appendectomy. During surgery, the appendiceal tip was completely attached and fused to a sigmoid diverticulum, which has not been reported elsewhere. The appendix was completely removed, and the patient was discharged from the hospital in a good general condition after two days.DiscussionAcute appendicitis can cause serious complications, such as ruptured appendix, abscess, or phlegmon. In most cases, inflammation and infection resolve by antibiotic administration. In some cases perforation of the inflamed appendix and local abscess or diffuse peritonitis formation, which requires immediate percutaneous drainage or surgery as indicated. Theoretically, the inflamed appendix can cause adhesive damage to the adjacent organs; however, there is no particular report on this type of damage.ConclusionThis rare case suggests that during phlegmon formation and related inflammation, other complications such as fistula formation, are theoretically expected.

Case report on Catatonic schizophrenia with encephalitis in a 14 years old child

Introduction : Catatonic schizophrenia (Cata: disturbed, tonic: tone) is distinguished by a substantial disturbance of motor behaviour. Excited catatonia, stuporous catatonia, and catatonia oscillating between excitement and stupor are the three clinical types. The inflammation of brain tissue is known as encephalitis. It might happen along the peripheral nerves or across the olfactory mucosa. Encephalitis can also be caused by an immune reaction. Case Presentation : A 14 years old child brought in AVBRH with the chief complaint of fever, cough, and cold since 8 days. Decreased oral intake since 2 days, irrelevant talk since 2 day. As narrated by the mother, patient was apparently well till 2 days, then patient had fever which was gradually onset, high grade, also chills and rigors, intermittent, vomiting, headache- throbbing in nature, abdominal pain, patient went to local practitioner for the some complaint where medication for fever and medication was given. Complete blood count (CBC) Initially lab test shows, Urine analysis, MRI Brain (plain and contrast) revels: no significant abnormally is seen. Electroencephalogram (EEG)-Abnormal EEG record. Antibiotics, corticosteroids, antacids, anti-convulsant, anti-psychotics, and multivitamins were given to the patient. Monitor all vital signs, checked and recorded intake and output, administered medication as prescribed. Conclusion : The patient was admitted in AVBRH with chief complaint of with the chief complaint of fever, cough, and cold, decreased oral intake, high grad fever vomiting, headache- throbbing in nature, abdominal pain, decreased oral intake and irrelevant talk. Members of the health team began therapy very away, and the patient’s condition is presently satisfactory.

Successful Treatment with Antibiotics Alone for Infant Rib Osteomyelitis

Pediatric rib osteomyelitis is a rare disease occurring predominantly in the neonatal period and early childhood and accounting for about 1% of all pediatric osteomyelitis. Compared to osteomyelitis in other parts of the body, pediatric rib osteomyelitis shows few localized findings (such as redness and swelling) and often an indolent lesion as well either of which may delay diagnosis and thus make treatment more difficult. A previously healthy one-year-old girl came to our department with a chief complaint of fever lasting for three days. She was admitted to our department to investigate her fever. At the time of admission, radiographs showed decreased permeability in the left lung field; so, we started antimicrobial therapy on the assumption of pneumonia. On the second day of admission, methicillin-susceptible Staphylococcus aureus was detected in the blood culture. A further, more detailed physical examination revealed some slight left anterior chest swelling. We performed a contrast-enhanced CT scan and an MRI and diagnosed her with rib osteomyelitis complicated with a chest wall abscess. She was given intravenous cefazolin for two weeks, switched to oral cephalexin for four weeks, and then recovered completely. She was treated without surgical intervention, having showed a good response to antimicrobial therapy. Osteomyelitis of the ribs in children is reported to be more common in the lower ribs and to occur more frequently in infants. In many cases, the earliest symptoms are nonspecific, so careful examination to detect any subtle abnormalities—such as swelling or mass—is of key importance for early diagnosis in infants. Regarding treatment, most cases of hematogenous osteomyelitis resolve with antimicrobial therapy alone—although surgical intervention may be required in cases of poor response to antimicrobial therapy. Therefore, early diagnosis of rib osteomyelitis through careful physical examination may reduce the chances of requiring surgical intervention.

Scrub Typhus in Intensive Care Unit in Kathmandu – A case series from a tertiary center

Scrub typhus is a rickettsial zoonosis caused by Orientia tsutsugamushi which can cause focal or disseminated vasculitis & perivasculitis in various body systems. It is endemic in many parts of Nepal & has been neglected & under-detected. We clinically assessed six patients from a intensive care unit in a tertiary hospital in Nepal that tested positive for scrub typhus using IgM ELISA & analyzed their profiles.
 Out of six patients, three were male & three were female with a mean age of 44.6 years. All six patients had chief complaints of fever & myalgia. Four patients presented with eschar. Three patients presented with septic shock while one presented with septicemia and meningoencephalitis. Only one patient had elevated white cell counts. Four out of six patients had transaminitis. Thrombocytopenia was present in two patients. Hypoalbuminemia was present in three patients. All cases tested negative for dengue, malaria, brucella, Leptospira, leishmania, salmonella & tuberculosis.
 This study points out the need for raising the index of suspicion & early screening of scrub typhus in patients with fever & laboratory findings of liver dysfunction or thrombocytopenia even with normal white cell counts.

High-Value Care During the COVID-19 Pandemic: Lessons Learned and Future Opportunities.

High-Value Care During the COVID-19 Pandemic: Lessons Learned and Future Opportunities.

ACUTE CORONARY SYNDROME AND COVID 19 ARDS: A RARE CASE REPORT OF REFRACTORY HYPERCOAGULOPATHY.

Novel coronavirus disease 2019 (COVID-19) is known to cause severe bilateral pneumonia and acute respiratory distress syndrome (ARDS), it is also presenting as severe hypercoagulable state, leading to serious complications such as pulmonary embolism (PE),[4] cerebral infarction,[5,6] or venous thromboembolism (VTE).[7]Less common manifestations include renal artery thrombosis,[8] acute myocardial injury,[9] and mesenteric ischemia.[10,11] Here we present a case of 40 year old non diabetic patient came with chief complaints of fever,dry cough and generalized bodyache which was diagnosed as having covid 19 pneumonia by RTPCR testing the next day. Patient had recurrent fever spikes, desaturation, tachycardia, Raised HbA1c on the third day. He was started on T. Favipinavir, followed by Inj.Remdesivir. Patient had worsening symptoms and landed up in cytokine storm on the 7th day. After giving 2 injections of Tocilizumab and 2 Convalescent plasma transfusions patient improved but had complications of fungal infections, post covid coagulopathy avascular necrosis of Femur Head and new onset diabetes mellitus. After being asymptomatic for 1 year patient had episode of Acute coronary syndrome. Patient was managed with Inj.Tenecteplase and underwent Coronary angiography which was suggestive of Thrombotic single vessel coronary artery disease of left anterior descending artery (LAD). As Pharmacoinvasive approach patient underwent percutaneous transluminal coronary angioplasty to LAD and was discharged asymptomatic. Patient had no cardiac or respiratory complaints on follow up.

A man with fever and aortitis

A 54-year-old man presented with a chief complaint of fever and pain around the left clavicle. He had a primary germ cell tumor of the mediastinum and had been undergoing chemotherapy for approximately six months. To prevent myelosuppression, pegfilgrastim was administered after each chemotherapy session. Pegfilgrastim was administered 4 days before the onset of fever and pain. On examination, he had a body temperature of 38.1 °C and pain in the left arm. Laboratory findings showed elevated C-reactive protein level (19.4 mg/dL).

Differential Diagnosis of Fever of Unknown Origin in Drug Reaction with Eosinophilia and Systemic Symptom (DRESS)

Objective: To describe an unusual case of drug reaction with eosinophilia and systemic symptoms presenting as fever of unknown origin (FUO) and the diagnostic hurdles that come with the presence of differential diagnosis of FUO, which is tuberculous lymphadenitis. Methods: A 34-year-old female with a chief complaint of fever that has lasted for 3 weeks accompanied with jaundice and skin rashes for 2 weeks was admitted with an indication of FUO. She had a history of carbamazepine consumption for trigerminal neuralgia 2 months prior. Cervical lymphadenopathy was palpable bilaterally and hepatomegaly, elevated liver enzyme, as well as hyperbilirubinemia were observed. After excluding differentials for many causes of prolonged fever, patient was treated for Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) and was given intravenous steroid injections. Fine needle aspiration biopsy was performed for her cervical lymphadenopathy. Results: Biopsy presented a mix of sialadenitis and tuberculous lymphadenopathy. Clinical improvement was observed on the second day after steroid administration. Patient was discharged on the seventh day after steroid administration. Conclusion: FUO is one of the possible manifestations of DRESS; however, thorough investigation still needed to be done considering the possibility of more than one entity of disease that can cause FUO in patients, such as tuberculous lymphadenopathy seen in this case.

Acute cerebral infarction due to severe COVID-19, bacterial meningitis due to Pseudomonas stutzeri, mild loculated pericardial effusion due to MIS-C

Neurological involvement was common in children and adolescents with Coronavirus disease-2019 (COVID-19) related hospitalization and is mostly transient. A spectrum of life-threatening neurologic involvement infrequently occurred and was associated with more extreme inflammation and severe sequel. We reported a patient male, seven months old with chief complaint of fever since 1 month before admission. The patient was diagnosed by confirmed case COVID-19 with a positive RT-PCR SARS-CoV-2 swab. He had some contact with his parents that had confirmed with COVID-19 before. The patient also complained with focal seizures in the left extremity with decreased of consciousness. The seizure always repeated every day for 1 week with the same pattern. Patient also complain of nausea and vomiting every time he has been breastfed. There is no changes of the lips and oral cavity, no cutaneous rash, no red eyes, no swelling or edema on extremities. Non-contrast head CT-Scan revealed large area of acute cerebral infarction. Echocardiography revealed mild loculated pericardial effusion and cerebrospinal fluid cultured result revealed Pseudomonas stutzeri. After 3 weeks discharged from the hospital, the patient underwent a head MRI examination and the results revealed chronic ischemic cerebral infarction and communicating hydrocephalus. The patient was planned to undergo a VP shunt as a treatment for hydrocephalus. The neurological involvement can occur in children and adolescents with COVID-19. The range of severe neurologic complications including peripheral nerve disorders, focal CNS disease and diffuse CNS involvement, make it likely that multiple mechanisms underlie this wide spectrum of disease.

Fever

Fever is one of the most common presentations of Systemic Lupus Erythematosus (SLE) (95%) but it is also associated with other manifestations. A 32-year-old female patient who presented with chief complaints of fever and burning micturition and during the course of the stay developed different manifestations like facial rash, leukopenia, proteinuria, and SLE was diagnosed on the antinuclear antibody (ANA) profiling of the patient and the clinical criteria. Here we present a case where the patient presented mainly with urinary tract infection which in turn acted as a trigger for immune reaction leading to the full-blown SLE.

Langerhans Cell Histiocytosis without Eosinophilia and Lytic Lesions of Bone: A Rare Disease with Unusual Presentation

LCH is a disease of abnormal clonal proliferation of langerhans cell of the bone marrow derived monocyte-macrophage lineage. Cells with characteristic coffee bean / grooved / indented nuclei with a background of histiocytes, lymphocytes, eosinophils and other inflammatory cells are seen. Clinical presentation varies from unifocal unisystem to multifocal unisystem to multifocal multisystem. We present a rare case of multisystem LCH involving high risk organs in a two and a half year old child. presented with the chief complaints of fever and red raised maculopapular lesions on trunk, palm, forehead and scalp for one and a half yrs with hepatosplenomegaly. There were no lytic lesions of the bones. Hematological parameters showed anaemia with thrombocytopenia while Bone Marrow Aspirate showed increase in histiocytic cell with some cells showing characteristic coffee bean, cleaved irregularly contoured nuclei. However, eosinophilia was not seen. Sections from the skin lesions showed cells with similar morphology without usually accompanied eosinophilia. The cells were CD1a and S100 positive. So a FINAL DIAGNOSIS of langerhans cell histiocytosis was made. The emphasis here lies on thorough analysis of the clinical presentations, imaging studies and scrupulous histomorphological and immunohistochemical examination, so that early diagnosis and timely intervention is ensured in such cases where the characteristic features like lytic lesions of bone and eosinophilia is not found.

An interesting case of Parkinsonism in the young

A 16-year-old female with no prior comorbidities came with chief complaints of fever and headache for 4 days associated with altered sensorium for the past 15 days in the form of decreased responsiveness. On general physical examination, Glasgow Coma Scale score was 6 with E1V1M4. Vitals were stable. Central nervous system examination revealed that bilateral pupils were sluggishly reactive to light. All extremities were rigid. A provisional diagnosis of viral encephalitis was made and was empirically started on acyclovir, doxycycline, ceftriaxone and vancomycin. Cerebrospinal fluid (CSF) showed lymphocytic pleocytosis, elevated proteins and normal glucose. CSF pan-neurotropic virus panel was negative. Serological testing for immunoglobulin M (IgM) against Japanese encephalitis virus positive. Magnetic resonance imaging of the brain showed symmetrical T2 hyperintense areas in the bilateral basal ganglia, thalamus and splenium of corpus callosum. The patient was started on oral levodopa plus carbidopa; sensorium became better and Parkinsonian features improved gradually.

Pleural Effusion in a Child With COVID-19: A Case Report

The coronavirus disease 2019 (COVID-19) outbreak started in December 2019. The disease can manifest in various respiratory and non-respiratory symptoms and clinical findings. The signs and symptoms of this disease in children are not entirely known yet. Ground-glass opacity and pleural effusion in the chest computed tomography scan have been reported in infected patients. The pleural effusion has been reported in a few cases. The present case report describes a pediatric patient with the chief complaints of fever, diarrhea, and vomiting who presented to an emergency department with a differential diagnosis of a gastrointestinal infection. However, he was diagnosed with COVID-19, which was complicated by respiratory distress and pleural effusion.

Eschar of scrub typhus.

We report a case of a 60-year-old farmer presented with chief complaints of fever, myalgia, and headache of one week duration. Head-to-toe examination revealed an area of central necrosis surrounded by erythema (suggestive of eschar) on nape of the neck. A diagnosis of scrub typhus was made and the patient improved following 7-days course of doxicycline. Eschar is pathognomonic finding for clinical diagnosis of scrub typhus. This is to conclude, head-to-toe examination is indispensable for all the patients presenting with fever, myalgia, and headache.

The time administration and cost burden of intravenous immunoglobulin (IVIG) therapy in a 4-year-old girl with Kawasaki disease: A case report

Kawasaki disease (KD) is an acute systemic vasculitis frequently affecting children under five years old. KD can cause severe complications. It can lead to coronary aneurysms in 15-25% of untreated cases. Intravenous immunoglobulin (IVIG) treatment within ten days of initial onset can reduce the rate of coronary artery aneurysms. However, IVIG administration in Indonesia is currently limited due to its high cost. The case reported a 4-year-old girl with a chief complaint of fever. She complained about a high fever seven days before hospitalization. She also complained about vomiting, cough, joint pain, diarrhea, skin peeling, and rash on her body, palms, and soles. On examination, she looked irritable and sluggish. The temperature was 39.9o C. There were red eyes without discharge, strawberry tongue, oral thrush, and red, dry, cracked lips, swollen neck lymph nodes, and skin rash on her body, palms, and soles. Laboratory testing showed microcytic hypochromic anemia with Hb 7.9 g/dL and leukocytosis 24.230/mm3. Chest X-ray showed perihilar and paracardial infiltrates. Electrocardiogram revealed sinus tachycardia. An echocardiogram showed left ventricle dilatation with trivial mitral regurgitation and no coronary abnormalities were found. She was diagnosed with Kawasaki Disease. She was treated by IVIG 30 gr single dose during 12 hours on day 7 of initial onset, methylprednisolone injection 10 mg/8 hours, paracetamol 150 mg/8 hours, and aspirin 400 mg/8 hours orally and discharged from the hospital with improvement. There weren’t any coronary artery abnormalities found. IVIG administration within ten days of initial onset in KD patients can reduce the risk of coronary artery complications. IVIG administration after day 10 of initial onset can achieve resolution of inflammation but can be insufficient for preventing coronary artery lesions (CALs).