Fever Research Articles

5164 Long COVID patients with menstrual symptoms: a retrospective study in Japan

Abstract Disclosure: F. Otsuka: None. Y. Sakurada: None. Y. Matsuda: None. T. Hasegawa: None. Y. Otsuka: None. Y. Nakano: None. K. Tokumasu: None. K. Yamamoto: None. N. Sunada: None. H. Honda: None. H. Hagiya: None. K. Ueda: None. It has been recognized that about one third of patients may suffer from prolonged illness after surviving from the acute phase of COVID-19. Various symptoms of the prolonged illness have been evaluated by many institutions including WHO. However, the mechanisms of the prolonged symptoms have yet to be elucidated. Long COVID is a complicated illness that develops after SARS-CoV-2 infection, independent of the severity of COVID-19. Long COVID is defined as symptoms that occur within 3 months after the initial infection and persist for at least 2 months. The major symptoms of long COVID include general fatigue, post-exertional malaise, headache, insomnia, dyspnea, cognitive dysfunction, low-grade fever, and muscle pain. Proposed pathophysiological mechanisms of long COVID include pathogen persistence and viral reactivation, immune dysregulation and autoimmunity, neurological abnormalities, tissue damage due to hypoperfusion and/or microclots, autonomic and endocrine dysfunctions, and dysregulation of microbiomes. In the present study, we aimed to elucidate the impact of long COVID on female reproductive health. In this retrospective study, medical records of patients who visited our long COVID clinic and clinical trends of their menstrual symptoms were evaluated. In our study, of 349 female patients who visited our clinic between Feb 2021 and Mar 2023, 223 patients with long COVID (18-50 years) were included. It was revealed that 44 females (19.7%) had menstrual symptoms associated with long COVID. The patients with menstrual symptoms were significantly older than those without menstrual symptoms (42.5 vs. 38 years). The percentage of patients with menstrual symptoms was higher during the Omicron phase (24%) than during the Preceding (13%) and Delta (12%) phases. Cycle irregularity (63.6%) was the most frequent menstrual symptom, followed by severe pain (25%), heavy bleeding (20.5%), perimenopausal symptoms (18.2%), and premenstrual syndrome (15.9%). Fatigue and depression were the most frequent complications with menstrual complaints. Scores indicating fatigue and QOL were significantly worse in long COVID patients with menstrual symptoms. Endocrine examinations showed significantly increased cortisol levels in patients with menstrual complaints although plasma adrenocorticotropin levels were not altered. Hence, long COVID has an impact on women’s reproductive and mental health. Presentation: 6/1/2024

6728 Bilateral Adrenal Hemorrhage: Cause Or Consequence?

Abstract Disclosure: M.N. Rayan: None. R. Horner: None. A. Valenciaga: None. L.E. Ryan: None. Introduction: Before the advent of the CT scan, bilateral adrenal hemorrhage was primarily discovered post-mortem in patients who had succumbed to sepsis, burns, or anticoagulant therapy. Today, non-traumatic hemorrhage is recognized as an infrequent, yet potentially lethal diagnosis causing clinical deterioration in acutely ill patients. Clinical Case: Our patient is a 64-year-old-male with a medical history of Myelodysplastic Syndrome initially presented to an external ED with abdominal pain. CT abdomen revealed hepatomegaly, splenomegaly, and new bilateral adrenal masses—absent in an MRI conducted a year earlier. He was treated conservatively and subsequently discharged. Two weeks later, he returned to the hospital with severe right sided flank pain. His hemoglobin and platelet counts dropped from 11.5 g/dL and 309 K/uL during the previous ED visit to 7.7 g/dL and 80 K/uL, respectively. Additionally, his PT/INR, PTT, fibrinogen, and D-Dimer levels were elevated. A repeat CT scan indicated a significant enlargement of the right adrenal mass, raising suspicion of adrenal hemorrhage. He was appropriately transfused, and a BM biopsy was performed to evaluate for acute transformation of underlying MDS. Cortisol levels were monitored daily for adrenal insufficiency. A complicated hospital course ensued marked by worsening anemia, thrombocytopenia, and coagulopathy, accompanied by high fevers and new-onset atrial fibrillation. Mixing studies showed absence of a factor inhibitor ruling out acquired forms of Hemophilia. Infectious workup including fungal and viral serologies returned negative. A PET scan revealed several small hypermetabolic hypodense liver lesions, and hypermetabolic activity diffusely in the spleen, and adrenal glands leading to suspicion of metastasis. Results of the BM biopsy returned revealing hypercellularity, with aggregates of hemosiderin-laden macrophages replacing the bone marrow space with associated necrosis. Worsening abdominal pain with hematochezia prompted an endoscopy, confirming a diagnosis of metastatic melanoma. Concurrently, seizure activity and altered mentation led to a head CT, revealing new metastatic lesions that confirmed the rapid progression of the disease. Subsequently, the patient was transitioned to comfort care and passed away. Clinical Lesson: It is crucial to review the various causes of adrenal hemorrhage, understand the challenges associated with interpreting adrenal imaging, emphasize the need to monitor adrenal function, and consider the occasional necessity for tissue sampling. In this clinical scenario, metastases with hemorrhage were the most likely etiology. The causes of adrenal hemorrhage are not always apparent; in this presentation, the consequence of the underlying disease state ultimately led to the initial presenting symptom of abdominal pain. Presentation: 6/2/2024

7901 Clinical Challenges Of Paraneoplastic Endocrine Metabolic Syndromes: An Illustrative Example

Abstract Disclosure: S. Shankar: None. S.S. Sundar: None. M.S. Vaishnav: None. K. Thummala: None. L. Lekkala: None. S. Srikanta: None. K. Muniraj: None. T. Deepak: None. R.B. Vijay: None. V. Nath: None. C. Siddlingappa: None. P. Ravikumar: None. M.D. Chitra: None. Introduction: Paraneoplastic endocrine syndromes result from aberrant production by tumors of protein hormones, hormone precursors, or hormone like substances. In patients who are already receiving treatment for cancer, the onset of a paraneoplastic syndrome may be an indication of progression or relapse. Clinical Case: 2021: Age 81 female (hypertension). Carcinoma rectum; S/P surgery, colostomy, chemotherapy and radiotherapy. 2023: Palliative care, due to progressive metastatic (hepatic, pulmonary, bone) malignancy. 2023 Aug: Hospital admission for generalized weakness, not able to walk, severe pain and low-grade fever 10 days. A: Paraneoplastic Hyponatremia: Evaluation: S Sodium= 127, 129, 129, 137, 134 mmol/L (134-145); Spot urine sodium= 65 mmol; S Uric acid= 3.5 mg/dL (4.4-7.6); S Cortisol 8 am= 15.5 (6.7-22.6); T3 total= 0.34 ng/mL (0.97-1.69), T4 total= 6.87 mcg/dL (5.5-11), TSH= 1.87 mIU/mL (0.46-4.68); LH= 0.35 mIU/mL (16-54); FSH= 1.9 mIU/mL (23-116); S calcium= 8.9 mg/dL (8.4-10.2); S Phosphorus= 2.31mg/dL (2.5-4.5) Diagnosis: Possible paraneoplastic ADH secretion/ SIADH; pain/ narcotics-induced hypothalamic ADH secretion. Treatment: Fluid restriction, liberal salt intake, 3% saline; oral sodium bicarbonate and tolvaptan; tapentadol. B: Paraneoplastic Leukemoid reaction: Evaluation: Total leucocyte count= 29960, 36670, 44130, 58450 cells/mm3 (4000-11,000); Differential count: Neutrophils= 85-94%; Lymphocytes= 10-4%; CRP= 93.7, 24.0 mg/dL (<0.3); Procalcitonin= 0.097, 0.083 ng/mL (<0.1); Ruled out significant sepsis; no obvious laboratory or imaging evidence of any infectious or leukemic etiology. Diagnosis: Progressive leucocytosis due to Granulocyte Macrophage Colony Stimulating Factor (GM-CSF) secretion from various neoplasms has been reported in literature. Treatment: Empirical antibiotic coverage. C: Paraneoplastic Hypokalemia: Evaluation: S Potassium= 3.3, 3.4, 3.7, 2.9, 3.0 mmol/L (3.5-5.1). Diagnosis: Hypokalemia likely due to (in vivo and in vitro) intracellular potassium uptake by rapidly proliferating leukocytes (and neoplasm- primary and metastatic). (Ectopic ACTH secretion / ruled out). Therapy: IV and oral potassium supplements. D: Paraneoplastic Fever: Cytokines (e.g., tumor necrosis factor and interleukin-1) release from tumor cells or infiltrating mononuclear cells. Clinical Lessons: Endocrine paraneoplastic syndromes can complicate patient’s clinical course, response to treatment, impact prognosis and even be confused as metastatic spread or another “non-existent” clinical entity. They can precede, occur concomitantly or present at later stage of tumour development. Recognition of the diverse clinical manifestations improves clinical outcomes (earlier cancer diagnosis, better quality of life, optimal tumour-directed therapy or decision towards non-aggressive focussed palliative care). Presentation: 6/2/2024

Phylogenetic tree and Molecular detection of Theileria velifera in sheep southern Iraq

Background: The purpose of this research was to ascertain T. velifera's evolutionary state in the Iraqi province of Al-Diwaniyah. In this investigation, the clinical assessment of fifty infected Blood samples (2.5 ml per animal) were collected from sheep, and a PCR technique was used to target the samples. Aim: This suggests that there may be intimate ties between certain global strains and our local ones. The vacuum tubes were coated with EDTA. Materials And Methods: The PCR and partial gene sequencing were conducted with the 18S rRNA gene serving as the molecular target. All of the examined samples had the targeted segments amplified at 400 bp according to the PCR, which used the 18S rRNA gene as genetic targets. Local T. velifera isolates' 18S rRNA gene sequences were compared to global reference strains of the species that were listed in the GenBank. Results: The local strains matched Chinese isolates 100% of the time and Chinese isolates Theileria luwenshuni 99% of the time. High fever (40.3–41.5°C), decreased appetite or appetence, asymmetrical enlargement of superficial lymph nodes, especially the pre-scapular ones, diarrhea in some cases, pale or icteric eye mucus membrane, lacrimation, sclera bleeding, abnormal movement, depression, dullness, and salivation were among the clinical signs displayed by diseased sheep. Conclusion: The information gathered from the current inspection effort may show how the local strains differ genetically from other strains listed in the GeneBank.

Peracute Enterotoxemia in Saanen and Alpine Goat Herd

Background: Enterotoxemia" or "overeating disease" is considered a common and often fatal disease affecting the economy of small ruminant breeding systems. This study presents findings on the occurrence of a peracute form of enterotoxemia in a herd of Saanen and Alpine, including an examination of the clinical signs, post-mortem findings, and methods for diagnosis. examination of the clinical signs, post-mortem findings, and methods for diagnosis. Methods: In a herd of goats a distressing situation occurred where the goats displayed signs (Sudden death and high fever) of peracute enterotoxemia (125 kids). It is noteworthy that these goats had previously been vaccinated against enterotoxemia. The onset of the condition seemed to be linked to three instances of interruption and reconnection of concentrate feed. To obtain a definitive diagnosis, the findings from postmortem examinations and ELISA were utilized. Results: In total, 60 Alpine and 65 Saanen succumbed to this peracute form. These losses occurred over three days but were successfully stopped by re-vaccination after two days. Clinical signs, postmortem observations, bacterial analysis, and ELISA results all provided confirmation of enterotoxemia. Notable findings included high fever (90%), duodenum hyperemia (89%), pulmonary edema (82%), convulsions (43%), and hemorrhage in the pericardium and endocardium (58%). Conclusion: Frequent and consecutive changes in goats' diet or discontinuation of concentrate supply by breeders can disrupt the vaccine-induced immune barrier, increasing the likelihood of enterotoxemia, and leading to casualties and economic losses. Consistent and stable nutrition practices are essential for maintaining vaccination efficacy and preventing enterotoxemia in goats, particularly kids.

A Young Female’s Battle with Toxic Epidermal Necrolysis Induced by NSAIDs: A Case Report

Introduction: Stevens-Johnson Syndrome (SJS) is a rare but severe mucocutaneous reaction often triggered by medications or infections, characterized by extensive epidermal detachment and mucosal involvement. This condition poses a high risk of morbidity and mortality, requiring prompt recognition and treatment. Case Presentation: An 18-year-old Asian female from eastern Nepal presented with non-itchy red spots, high fever, and significant discomfort following the administration of ibuprofen for minor sores. She developed extensive skin involvement covering 25% of her body surface area and severe mucosal lesions. Laboratory investigations revealed anemia, leukocytosis, and coagulopathy. She was admitted to the ICU, where she received broad-spectrum antibiotics, corticosteroids, and supportive care. The patient also developed acute kidney injury during treatment but eventually recovered and was discharged after a week. Clinical Discussion: The rapid onset of SJS in this patient reveals the unpredictable nature of drug-induced reactions. Early intervention with a multidisciplinary approach involving dermatology, intensive care, and infectious disease specialists was crucial in managing her condition. Despite the controversy surrounding corticosteroid use in SJS, their administration likely contributed to the rapid improvement in inflammation and skin healing. The case highlights the importance of early recognition, prompt management, and careful monitoring for adverse drug reactions, especially when prescribing medications known to cause SJS. Conclusion: The successful outcome achieved through a multidisciplinary approach provides valuable insights into the effective strategies for handling severe drug reactions, emphasizing that early diagnosis and comprehensive management in patients with SJS is critical.

Efficacy assessment of intravenous immunoglobulin for gastrointestinal involvement in systemic sclerosis using UCLA SCTC GIT: Case-based review

Objectives: To summarize the published evidence in the literature on the use of intravenous immunoglobulin in gastrointestinal tract involvement in systemic sclerosis patients and report the experience of our department. Methods: A systematic literature review was performed; and a literature search was conducted in MEDLINE and Embase until 1/5/2024, using the participants, intervention, comparator and outcomes framework. Only full-text articles involving systemic sclerosis adults, submitted to intravenous immunoglobulin (at least one administration) to treat primary gastrointestinal tract manifestations. The outcome was the University of California at Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 score to evaluate response to treatment. Two reviewers performed the assessment of data extraction and synthesis, independently. Results: Four papers (two case reports and two retrospective studies) out of 35 references were included. In addition, we added two systemic sclerosis patients from our department in this review. In 25 systemic sclerosis patients, with various gastrointestinal tract manifestations, the intravenous immunoglobulin therapy was found to improve digestive tract symptoms in SSc patients, as shown by the decrease in the scores of University of California at Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0. No adverse events were reported, except for one case of low-grade fever post-administration. Conclusion: The results from this systematic literature review based on case series suggest that intravenous immunoglobulin may improve gastrointestinal tract symptoms assessed by the University of California at Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 scale, with only minor reported adverse events, suggestive of an acceptable safety profile. We believe that this systematic literature review will contribute to shed light on the efficacy and safety aspects of intravenous immunoglobulin treatment in the management of gastrointestinal tract symptoms; and multicenter randomized placebo-controlled trials are urgently needed to foster progress in this field.

Septic paravertebral abscess and inferior vena cava thrombosis complicated by uro-sepsis: Case report

Paravertebral abscess is an uncommon and potentially dangerous illness characterized by the buildup of pus in the anatomical area surrounding the spinal column. A 65-year-old female, who has diabetes and high blood pressure, came in with intense discomfort in her lower back that spreads to her lower limbs, making it difficult for her to move. She also has a high fever, excessive sweating, and has lost a large amount of weight. The blood tests indicate the following abnormalities: low Hb level of 9.6 g/dl, low MCV of 70 fl, elevated total white blood cell count of 15.8 × 109/L, elevated neutrophil count of 12.4 × 109/L, normal lymphocyte count of 2.8 × 109/L, high platelet count of 485 × 109/L, and elevated ESR of 110 mm/hr. The level of phosphatase was raised to 247 U/L, which is beyond the usual range of 40-150 U/L. The blood film reveals the presence of hypochromic microcytic red blood cells, which are indicative of iron deficiency anemia. There is also evidence of neutrophil leukocytosis in the white blood cells, with no immature cells observed. Additionally, an increase in platelets is observed in the film. The D-dimer level is 2009 ng/ml, which is within the normal range of less than 500 ng/ml. The CRP level is 48 gm/l, which is above the usual range of less than 6 gm/l. The bone marrow testing yielded normal results. The blood culture indicated the presence of Streptococcus epidermidis growth. Radiological tests revealed that a CE-MRI of the dorsal and lumbar spine indicated the presence of a para-aortic abscess together with septic thrombosis of the inferior vena cava. Paravertebral abscess is a critical emergent condition required a necessary therapy protocols to stabilize the patient status. The timing of intervention is crucial in cases of paravertebral abscess, as the existence of a mass can led to spinal cord compression.

Utilizing the '5 in 1 Magic Touch' CCRTV method for early detection of severe dengue warning signs in pediatric patients: A case study from a Type C Hospital in Indonesia

Background: Dengue fever, prevalent in tropical and subtropical regions, is recognized by WHO as a significant global health threat. Early detection of severe dengue symptoms, especially in resource-limited settings, is critical for patient outcomes. The "5 in 1 Magic Touch - CCRTV" method, which evaluates Color, Capillary Refill Time, Temperature, Pulse Rate, and Pulse Volume, provides a simple yet effective approach to monitor hemodynamics and identify early warning signs of severe dengue. Case Description: In a case study, a 3-year-old boy was admitted with fever, shortness of breath, weakness, nausea, vomiting, and epigastric pain. On the third day, he entered a critical phase with symptoms of pale extremities, delayed capillary refill time, high fever, and a weak, rapid pulse. Thorax examination revealed severe plasma leakage, pulmonary edema, and right pleural effusion, indicating a pre-shock state. The patient required close clinical monitoring, regular fluid balance management, and frequent blood tests to guide treatment. Conclusion:The CCRTV assessment method allowed for the early identification of the pre-shock condition, facilitating timely and appropriate intervention. This case highlights the potential of the CCRTV method for improving prognosis in severe dengue cases. The effectiveness of this method warrants further research, particularly in its ability to predict outcomes and improve recovery rates in children with severe dengue.

Recurrent pulmonary nocardiosis due to Nocardia Otitidiscaviarum in a patient with isolated CD4 lymphocytopenia: a case report

BackgroundIdiopathic CD4 lymphocytopenia (ICL) is an underdiagnosed immunodeficiency syndrome characterised by persistent low CD4 counts in the absence of HIV and other causes of lymphocytopenia. ICL patients are susceptible to opportunistic infections, with human papillomavirus, cryptococcal, and tuberculosis being the most common infections reported. Nocardiosis is rarely reported in patient with ICL.Case PresentationWe herein discuss a 46-year-old female presented with complaints of weight loss, low grade fever and cough with expectoration from last four months. The patient was diagnosed with pulmonary nocardiosis and aspergillosis co-infection four years back; in addition she also had ICL. Subsequently, the patient was lost in follow-up and readmitted four years later. Bronchoalveolar lavage sample shows the presence of acid-fast bacilli in modified gram stain, which later identified as Nocardia otitidiscaviarum by metagenomic next-generation sequencing. Her CD4 counts were still found low (298 cells/mm3). After an initial improvement with trimethoprim-sulfamethoxazole (TMP-SMX), she was commenced on indefinite secondary prophylaxis.ConclusionsNocardiosis without usual risk factors should be evaluated for ICL. This case emphasize the importance of periodic follow-up with CD4 count monitoring and secondary prophylaxis therapy to prevent recurrence or the emergence of new infections in ICL.Clinical trial numberNot applicable.

Atypical pneumonia caused by Chlamydia abortus in HIV patient: a case report

BackgroundChlamydia abortus, as a pathogen of atypical pneumonia, is rare in humans, especially in HIV infection patients.Case presentationWe present the case of a 48-year-old man with a history of HIV infection who started high fever and developed pneumonia. The pathogen-targeted next-generation sequencing (ptNGS) results of bronchial lavage fluid showed Chlamydia abortus infection.ConclusionThis is the first report of Chlamydia abortus infection presented as atypical pneumonia in an AIDS patient.

Brown fat fuels the fire in fever

Fever is a host-pathogen defense mechanism in which the immune system drives a physiologic increase in core body temperature. For over 50 years, it has been known that the temperature of brown adipose tissue (BAT) is increased during the febrile response. However, recent studies suggested that the primary thermogenic protein Uncoupling protein 1 in brown adipocytes does not contribute to fever induction in mice, casting doubt about the functional contribution of BAT to fever. In a new set of studies, Li et al. (2024) provide compelling evidence that fatty acid oxidation is markedly increased in BAT in a Salmonella infection model of fever and strongly suggest that metabolic adaptation in BAT may play a critical role in the febrile response. This article re-opens the debate about how thermogenic and metabolic programs in BAT contribute to fever and raises new questions about whether BAT contributes to host defense against pathogens.

Clinical and epidemiological investigation of human infection with zoonotic parasite Trypanosoma dionisii in China

BackgroundTrypanosomiasis continue to pose a global threat to human health, with human infection mainly caused by Trypanosoma brucei and Trypanosoma cruzi. MethodsWe present a 30-year-old pregnant woman with persistent high fever from Shandong Province, China. High-throughput sequencing revealed the presence of Trypanosoma dionisii in blood. We conducted an analysis of the patient’s clinical, epidemiological, and virological data. ResultsThe patients exhibited fever, shortness of breath, chest tightness, accompanied by change in liver function and inflammatory response. She made a full recovery without any long-term effects. T. dionisii was detected in blood collected 23 days after onset of illness. The 18S rRNA gene sequence showed close similarity to T. dionisii found in bats from Japan, while the gGAPDH gene was closely related to T. dionisii from bats in Mengyin County, Shandong Province. Phylogenetic analysis demonstrated the current T. dionisii belongs to clade B within its species group. Positive anti-Trypanosoma IgG antibody was detected from the patient on Day 23, 66 and 122 after disease onset, as well as the cord blood and serum from the newborn. Retrospective screening of wild small mammals captured from Shandong Province revealed a prevalence rate of 0.54% (7/1304) for T. dionisii; specifically among 0.81% (5/620) of Apodemus agrarius, and 0.46% (2/438) of Mus musculus. ConclusionsThe confirmation of human infection with T. dionisii underscores its potential as a zoonotic pathogen, while the widespread presence of this parasite in rodent and bat species emphasizes the emerging threat it poses to human health.

Association of Prenatal Maternal Fever and Neonatal Umbilical Artery Blood-Gas Analysis: Evidence from a Tertiary Center at China

Background: Neonatal umbilical artery blood-gas analysis is a diagnostic procedure performed shortly after birth to assess the acid-base balance, oxygenation, and metabolic status of a newborn infant. This retrospective study aimed to investigate the association of prenatal maternal fever with neonatal umbilical artery blood-gas analysis. Methods: A retrospective analysis was conducted on data from 333 parturients and their newborns. Demographic characteristics, clinical information, and neonatal umbilical artery blood gas analysis data were analyzed to evaluate the association between prenatal maternal fever and neonatal blood-gas analysis. Pregnant women with fever (≥38.0 °C) during labor were compared with those without fever. Neonatal umbilical artery blood gas parameters were assessed in relation to the degree and duration of maternal fever. Results: The incidence of the adverse delivery outcome of parturients with high prenatal fever and long duration of fever was significantly higher than that of the low fever, short-term fever, and normal parturients (p < 0.05). The pH of neonatal umbilical veins in the high fever groups was reduced compared with the control group (p < 0.05). Lactic acid (Lac) of neonatal umbilical vein in the low fever and high fever groups was enhanced compared with the control group (p < 0.05). The pH of neonatal umbilical veins in the short-term fever and long-term fever groups was elevated compared with the control group (p < 0.05). The umbilical artery pH and base excess (BE) were positively correlated with maternal peak fever temperature (r = 0.20, r = 0.22, p < 0.05). The umbilical Lac was negatively correlated with maternal peak fever temperature (r = –0.22, p < 0.05). Moreover, the umbilical artery pH and BE were positively correlated with maternal duration of fever (r = 0.29, r = 0.21, p < 0.05). The umbilical artery Lac was negatively correlated with maternal duration of fever (r = –0.25, p < 0.05). Conclusions: The findings suggested that maternal fever during labor was associated with alterations in neonatal umbilical artery blood gas analysis. Understanding the influence of prenatal fever on delivery outcomes is crucial for optimizing maternal and neonatal health.

Kikuchi–Fujimoto disease and primary Sjögren’s syndrome coexisting: A case-based literature review

ABSTRACT Kikuchi–Fujimoto Disease (KFD), also known as Kikuchi histiocytic necrotising lymphadenitis, is an extremely rare and benign condition that mostly affects young women. It is characterised by lymph node involvement with a predilection for the cervical region, commonly presenting with tender lymphadenopathy and a low-grade fever. The diagnosis requires excisional lymph node biopsy with immunohistochemical analysis. KFD is mostly self-limiting within a few weeks to months, with only some patients requiring symptomatic relief with non-steroidal anti-inflammatory drugs or corticosteroids, and a minority developing recurrent episodes of the disease. Importantly, it has been reported in association with systemic lupus erythematosus and, to a lesser extent, other immune-mediated inflammatory rheumatic diseases, such as Sjögren’s syndrome, whose clinical presentation itself may include lymphadenopathy. In this paper, we present an unusual case of a woman with primary Sjögren syndrome (pSS) and a past medical history relevant for lymphoma, sarcoidosis, and thymoma, who later developed KFD, a particularly challenging diagnosis in this setting. We then performed a literature review of the association between KFD and pSS, gathering a total of 13 patients, and focusing epidemiological, clinical, and laboratory data.

Febrile neutropenia induced by adjuvant radiotherapy for a patient with breast cancer accompanied with reversible splenial lesion syndrome (RESLES, TypeI): a case report

BackgroundReversible splenial lesion syndrome (RESLES) is known as a neuro-imaging syndrome with recurrent but reversible lesion of the corpus callosum, characterized by nonspecific but usually mild encephalopathies and specific imaging manifestations.There are few published reports in the field of oncology.Case presentationA 33-year-old female with right breast cancer and with no particular family history was admitted to hospital with high fever and severe headache, after receiving adjuvant radiotherapy. Blood routine test upon admission suggested neutropenia, considering myelosuppression associated with radiotherapy. There were no definite findings of common pathogenic microorganism, and no imaging indication of certain infectious sites other than a likely reversible corpus callosum syndrome suggested by brain MRI, which was relieved after systemic antibiotic therapy and granulocyte colony-stimulating factor injection.ConclusionsReversible splenial lesion syndrome is a kind of clinical-imaging syndrome with multiple clinical manifestations and etiologies. This breast cancer patient after postoperative adjuvant radiotherapy develops a complication of RESLES that rings an alarm bell to the oncologists not to easily recognize the corpus callosum lesion as infarction or metastasis. Meanwhile, the potential pathogenic mechanisms need to be explored further.

Relationship between post-ablation fever and prognosis in initial hepatocellular carcinoma: A 15-year multicenter, retrospective cohort study.

Fever is a common side effect following thermal ablation in patients with hepatocellular carcinoma (HCC), yet its impact on prognosis remains unclear. This retrospective study included initial HCC patients who underwent US-guided percutaneous microwave ablation at 13 hospitals between January 2006 and February 2021. All patients were categorized into afebrile, transient low-grade fever (TLF), and prolonged or high-grade fever (PHF) groups. Primary outcomes included very early recurrence (VER) and early recurrence (ER), secondary outcomes were disease-free survival (DFS) and overall survival (OS). Fever cut-offs for VER/ER were established using restrictive cubic splines and adjusted Cox model. Survival analyses used the Kaplan-Meier method. A total of 1458 initial HCC patients (mean age, 59±11[SD]; 1146 men). Compared to afebrile individuals, patients with TLF (temperatures ranging 37.0-38.8°C for 1-2d), showed independent protective effects against VER (HR, 0.73; 95% CI: 0.57,0.95; P=0.02) and ER (HR, 0.66; 95% CI: 0.54,0.81; P<0.001), however, PHF showed no differences in VER (HR, 0.99; 95% CI: 0.76,1.30; P=0.96) and ER (HR, 0.86; 95% CI: 0.69,1.07; P=0.17). With a median follow-up of 47 months (IQR:26-79), the median DFS for TLF patients was 40 months, superior to afebrile (30mo, P=0.019) and PHF patients (33mo, P=0.049). The 5-year OS rate for TLF patients was 73.2%, higher than afebrile (69.3%, P=0.02) and PHF patients (66.7%, P=0.03). No significant difference was found in DFS and OS between afebrile and PHF patients (P=0.90 and 0.71). Notably, TLF patients exhibited the highest lymphocyte counts increasing median 7 days after ablation (P<0.001 vs. afebrile and P=0.01 vs. PHF). Transient low-grade fever following percutaneous microwave ablation in hepatocellular carcinoma patients demonstrated protection against early recurrence, possibly attributed to the short-term activation of lymphocytes.

An FUO patient diagnosed as appendicitis: a case report

BackgroundThe diagnosis and management of fever of unknown origin pose significant challenges in the field of infectious diseases, as it is influenced by various factors. Infectious diseases have long been recognized as the primary etiology of fever of unknown origin. However, not all infectious diseases can definitively identify the causative pathogen and infection sites.Case presentationwe present a case report of an individual with fever, nausea, and anorexia but did not report any abdominal pain. Physical examination revealed no signs of abdominal tenderness. Repeated imaging studies including enhanced CT and color US of the appendix, only one color US suggested the possibility of appendicitis. Despite effective anti-infective treatment, the patient continued to experience low-grade fever, leading to the decision for laparoscopic exploration and subsequent appendectomy. Pathological findings confirmed the presence of appendicitis. After the surgical procedure, the patient’s temperature and infectious markers returned to within normal range, ultimately leading to a diagnosis of appendicitis.ConclusionsThe atypical symptoms and signs, along with the negative imaging results, contribute to the under diagnosis of appendicitis and the progression of fever of unknown origin, thereby exacerbating the physical, mental, and economic burden on patients. Consequently, there are valuable insights to be gained regarding the management of both appendicitis and fever of unknown origin.

Beyond the spine: a case of ankylosing spondylitis complicated by secondary amyloidosis

BackgroundAnkylosing spondylitis (AS) is a chronic inflammatory condition primarily affecting the spine and sacroiliac joints, often associated with human leukocyte antigen B27 (HLA-B27) positivity. While musculoskeletal symptoms are typical manifestations, AS can also lead to systemic complications, including secondary systemic amyloidosis (SSA), also known as Amyloid A (AA) amyloidosis, involving multiple organs.Case presentationWe present a case of a 45-year-old Asian male with a complex medical history, including diabetes and hypertension, who developed AS complicated by SSA. The patient exhibited a diverse range of symptoms, including cardiac, renal, gastrointestinal, and musculoskeletal manifestations. He reported shortness of breath on exertion, orthopnea, pedal edema, generalized weakness, back pain, neck pain, low-grade fever, decreased appetite, frothy urine, and significant weight loss over the past year. Diagnostic evaluations revealed HLA-B27 positivity and histologically confirmed AA amyloidosis, providing a comprehensive understanding of the systemic involvement.ConclusionThis case report highlights the intricate interplay between AS and SSA, particularly AA amyloidosis, with a focus on its systemic impact beyond musculoskeletal symptoms. The tragic outcome, marked by severe cardiac involvement, underscores the challenges in managing such complex cases. This report emphasizes the importance of early diagnosis and treatment of AS to prevent severe complications, along with vigilant monitoring and individualized treatment plans, as well as the need for further research to enhance our understanding and improve management strategies for AS-related amyloidosis.

Anakinra in the management of adult-onset still's disease: a single-center experience.

Adult-onset Still's disease (AOSD) is a rare systemic autoinflammatory disorder of unknown etiology characterized by systemic inflammation, high fever, salmon-colored skin rash, arthralgia, and arthritis. Patients with AOSD may also present with elevated inflammatory markers, hyperferritinemia, anemia, leukocytosis, hepatosplenomegaly, and lymphadenopathy. Glucocorticoids and biological disease-modifying anti-rheumatic drugs, including the anti-interleukin-1 agent anakinra, are used in the management of AOSD. This retrospective single-center study included patients with AOSD who were registered at our tertiary center, and received anakinra treatment. The primary outcome of our study was the proportion of patients who achieved complete remission of disease-related clinical and laboratory complications. The glucocorticoid treatment profiles of the included patients before and after anakinra treatment were also analyzed. The occurrence of serious and non-serious adverse events was recorded to analyze the safety profile of anakinra. Thirty-four patients with AOSD, including 25 females (73.5%), were enrolled in the study. Twelve patients (35.3%) achieved complete remission and 14 patients (41.2%) achieved partial remission after anakinra treatment. Eight patients (23.5%) did not response to anakinra. Anakinra significantly decreased the number of patients receiving glucocorticoid treatment [33 (97%) vs. 22 (64.7%), p < 0.001] and the mean daily glucocorticoid dose [19 ± 13.5mg vs. 4.6 ± 5.8mg, p < 0.001]. Mild adverse events occurred in 11 patients (32.3%) with injection site reactions being the most common. One patient (2.9%) was diagnosed with tuberculosis within the treatment period. Anakinra is an effective and generally safe option for biological treatment initiation in the management of AOSD.