35 year old man with fever, weight loss and splenomegaly

ABSTRACT

A 35 year - old man was referred to an infectious disease specialist because of two weeks; fever, fatigue, 4kg weight loss and an obscure pain of whole body. He had otherwise been well until 1 5 days before. 10 days before; treatment with Procaine Penicillin [800,000 U per 12 hours] and Amoxicillin by a G.P was begun. 5 days later a physician sent him to a lab for routine blood examination and febrile agglutination tests. His physician on physical examination of patient found a palpable spleen and his temperature was 38c, CRP+ + and ESR was 45 mm per h our. In auscultation, heart and lungs were normal. A urine culture was negative.Blood sugar, Creatinine, Cholesterol and Triglycerides were normal. Hematologic lab values were Hct%40, MCV 82, WBC [Per mm3] 9 100, dif count N=35, L=55, E=O, M=8, B=2, PLT250 000, Blood *chemical *values Creatinine 0.9, Sugar 95, Calcium normal, Liver enzymes; ALT=50, AST=48. And Tuberculin Test positive with 12 mm indurations. The patients' weight had dropped from 75 to 71 Kg. The temperature was 38 c.The pulse rate was 75, respiration rate was 22. The blood pressure was 1 10/70. The urine was positive [++] for protein, Urea Nitrogen 33 mg/dl, Creatinine 1.2mg/dI. Na 139 mmol; K, 4.5mmol/lit; Glucose 119 mg/dl; Bilirubin total 1.7 and direct 0.6; and normal liver enzymes, EKG showed sinusal tachycardia; the other findings were otherwise normal. Chest X-Ray showed no abnormality. Sample of blood was obtained for culture. Temperature was controlled each day and it was maximum 38.3 centigrade. On the next clinical visit of patient,three days later, serum sample obtained on the seventh day of illness was negative for Salmonellosis and Brucellosis and first report of blood culture was negative too. A CT-Scan of lumbo-saccreal portion and Chest x Ray gave no diagnostic information A diagnostic procedure was performed