Cases reported "Fever of Unknown Origin"

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11/313. A patient with bilateral primary adrenal lymphoma, presenting with fever of unknown origin and achieving long-term disease-free survival after resection and chemotherapy.

    Primary adrenal lymphoma is extremely rare. We describe a 64-year-old female patient who presented with fever of unknown origin. Imaging studies demonstrated bilateral bulky adrenal masses. She underwent bilateral adrenalectomy and the pathological diagnosis was large cell immunoblastic (B-cell) lymphoma. She received adjuvant combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone in the following 6 months. She has been relapse free for 52 months. To the best of our knowledge, this case has the longest disease-free survival among those reported. The present case indicated that primary adrenal lymphoma should be included in the differential diagnosis of fever of unknown origin and/or suprarenal mass. Chemotherapy following surgical resection may be considered the treatment of choice.
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12/313. bacteroides fragilis bacteremia and infected aortic aneurysm presenting as fever of unknown origin: diagnostic delay without routine anaerobic blood cultures.

    We report the case of a 71-year-old male with bacteroides fragilis bactermia and infected aortic aneurysm that went undiagnosed, in part, because routine anaerobic blood cultures were not obtained. bacteremia caused by anaerobes has been reported to be declining, and recommendations to discontinue routine anaerobic blood cultures have been implemented in some hospitals. To our knowledge, this is the first report of an anaerobic bacteremia and infection that had a delay in diagnosis due to this change in blood-culturing protocol. The potential impact of deleting anaerobic blood cultures from routine protocols is discussed.
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13/313. Kikuchi's disease: an uncommon cause of fever of unknown origin.

    Kikuchi's disease or histiocytic necrotizing lymphadenitis is an uncommon clinical condition that causes diagnostic difficulties because of its lack of specific signs, symptoms and serological markers. diagnosis is based on histopathological findings, but overlapping of the histological features requires a differential diagnosis among histiocytic necrotizing lymphadenitis and a number of infectious, autoimmune and lymphoproliferative lymphadenopathies. We report a case of Kikuchi's disease in a 19-year-old woman presenting with generalized lymphadenopathy and persistent fever.
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14/313. A patient with fever and an abdominal aortic aneurysm.

    A 55-year-old man with an abdominal aortic aneurysm presented with fever and abdominal pain 3 weeks after an episode of salmonella gastroenteritis. His symptoms persisted despite antimicrobial therapy. Two abdominal computed tomography (CT) scans showed no evidence of aortitis. His abdominal pain worsened and further investigation including a third CT scan demonstrated a leaking aortic aneurysm. The wall of the aorta was shown to contain Gram-negative bacilli. This case illustrates the difficulty in diagnosing bacterial aortitis.
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15/313. abscess of an accessory spleen.

    Accessory spleens are not infrequent and occur in 11 to 44 per cent of the population with a greater incidence in those with hematological disease. They may remain clinically silent or result in a number of pathologic processes. abscess of an accessory spleen is rare but must be considered in the differential diagnosis of fever of unknown origin or sepsis in select groups of patients. Computerized tomography is the imaging modality of choice and may also be used in the percutaneous drainage of select cases. Laparoscopic splenectomy in the hands of the experienced laparoendoscopic surgeon is a viable treatment option.
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16/313. Retractile mesenteritis presenting as fever of unknown origin and autoimmune haemolytic anaemia.

    Retractile mesenteritis is an extremely rare disease characterised by a non-specific inflammatory and fibrotic process of the mesenteric adipose tissue, which is usually accompanied by pain and a variety of other abdominal symptoms. We describe here the case of a patient with retractile mesenteritis presenting with prolonged high-grade fever and autoimmune haemolytic anaemia without abdominal symptoms. The patient's illness was complicated by chylous ascites. diagnosis was suspected by computed tomography and confirmed histologically following exploratory laparotomy. The patient was treated with prednisone and azathioprine, and he had a rapid improvement in anaemia and fever relief, but no substantial change in the mesenteric lesions. Our case adds autoimmune haemolytic anaemia to the wide spectrum of manifestations of retractile mesenteritis and implies the possible involvement of immune mechanisms in the pathogenesis of the disease.
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17/313. Spinal neurenteric cyst presenting in infancy with chronic fever and acute myelopathy.

    The authors describe the clinical, radiologic, and pathologic features of a neonatal spinal neurenteric cyst (NC) presenting with long-lasting fever and acute myelopathy, and compare this observation with other infants reported in the literature. This observation shows that NC must be considered in the differential diagnosis of acute myelopathy with persistent fever in infancy. Fever is attributed to degenerative changes in the NC, triggering inflammatory cell infiltration and tumor necrosis factor alpha secretion.
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18/313. Intestinal tuberculosis presenting as fever of unknown origin in a heart transplant patient.

    patients undergoing transplantation have an increased risk of developing infections such as tuberculosis, pneumocystis carinii pneumonia, candida infections or cytomegalovirus infections because of their immunosuppressive therapy with cyclosporin A, azathioprine and steroids. Mycobacterial infection is well recognized as a complication in the immunocompromised host but diagnosis and therapy are very difficult.
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19/313. fever of unknown origin in a 10-year-old boy with allergic rhinitis and asthma.

    We believe this case represents a clear example of drug fever, and it appears to be the first report to implicate ketotifen as the responsible agent, confirmed with double rechallenge. The recognition of drug fever is clinically important. Failure to recognize the etiologic relationship between the drug and fever has unnecessary consequences, including extra testing, empiric therapy, and longer hospital stays. We suggest that ketotifen should be considered as a possible cause of fever in allergic patients receiving this drug.
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20/313. Subacute thyroiditis manifesting as fever of unknown origin.

    Subacute thyroiditis (SAT) usually occurs in women in middle age with a viral prodrome, thyroid or neck tenderness, classic symptoms of thyrotoxicosis, and elevated erythrocyte sedimentation rate (ESR). We report a case in an 81-year-old man who initially had 2 days of fever to 101.2 degrees F, confusion, and bilateral lower extremity weakness. Extensive evaluation was remarkable only for the following laboratory values: thyrotropin (TSH) 0.02 microIU/mL, free thyroxine (FT4) 3.1 ng/dL, free triiodothyronine (FT3) 6.0 pg/mL, and ESR 98 mm/hr. One week later, the patient had persistent fevers to 102 degrees F; no source was found. The fever resolved, and 3 months later the patient had profound hypothyroidism (TSH >44.0 microIU/mL, FT4 0.4 ng/dL, ESR 13 mm/hr). A painless thyroid gland and atypical manifestations of hyperthyroidism are unusual in SAT. When fever is of unknown origin, SAT should be considered even if classic features are absent.
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