ABSTRACT
We described a case of a 30-year-old Filipino woman who presented with fevers, night sweats, left hip pain, painful scalp lesions, and a neck mass. Symptoms began 6 months earlier, with nasal drainage, fever, cough, and occasional hemoptysis, which did not resolve with outpatient antibiotics. A further workup revealed lymphadenopathy and several lytic bone lesions. Her hospital course was later further complicated by the development of a tracheoesophageal fistula secondary to an esophageal mass and, then later, aseptic meningitis. Extensive diagnostic workup and immunologic tests were performed and finally led to the diagnosis. Here, we discussed the diagnostic workup and pathophysiology of the underlying condition. This case illustrated the importance of appropriate immunologic workup to make the diagnosis of a rare condition that proves to be clinically significant and presents challenges in management.
Subject(s)
Autoantibodies/immunology , Immunologic Deficiency Syndromes/diagnosis , Interferon-gamma/immunology , Mycobacterium avium-intracellulare Infection/diagnosis , Osteolysis/diagnostic imaging , Tracheoesophageal Fistula/diagnostic imaging , Adult , Female , Fever/etiology , Hip , Humans , Immunologic Deficiency Syndromes/complications , Immunologic Deficiency Syndromes/immunology , Lymphadenitis/diagnosis , Lymphadenitis/etiology , Meningitis, Aseptic/diagnosis , Meningitis, Aseptic/etiology , Mycobacterium avium-intracellulare Infection/etiology , Mycobacterium avium-intracellulare Infection/immunology , Osteolysis/etiology , Philippines/ethnology , Tracheoesophageal Fistula/etiologyABSTRACT
We presented a case of a 69-year-old woman who experienced monthly episodes of facial swelling and nonpruritic, erythematous rash on her face, accompanied by high fever, nausea, headache, and neck pain over 1 year. Her symptoms started with myalgia, arthralgia, fever and neck stiffness, and headache, and then angioedema occurred, which was painful to touch. She underwent multiple iatrogenic diagnostic and therapeutic procedures that did not lead to the correct diagnosis. Subsequently, relevant immunology laboratory tests were conducted after a careful history and physical examination, which led to the diagnosis. This case illustrated the need for a detailed history and thorough immunologic assessment, and the requirement to maintain a broad differential diagnosis.
