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Re: Diagnostic Challenge at Ben Taub HospitalFrom: Dr. Carlos Chase (drchase@caribnet.net)Sat Oct 28 19:24:00 1995
On Sat, 28 Oct 1995, gklein@bcm.tmc.edu (Geffrey Klein, MD) wrote: >I would like to enlist the readership's assistance for this diagnostic >dilemma. I admitted this patient last night and would like suggestions: > >_______ >This patient is a 28 y/o G4P3 mexican female at 13 6/7 wks who's chief >complaint is recurrent fevers for 2 weeks. She complains of chills and >night sweats, fatigue, anorexia, and dark urine during this time. >She presented to clinic with a fever of 102.9. She denies any other >symptoms.. No headache, neck pain, sinus pain, earache, sore throat, >lymphadenopathy, photophobia, chest pain, shortness of breath, cough, >abdominal pain, nausea, vomiting, diarrhea, rectal pain, constipation, skin >lesions, or muscle aches... >There are no sick contacts. > >Her past medical and surgical history are unreamarkable >She is on no medication and has no known drug allergies >Her social history is remarkable for recent immigration from central >Mexico. She lived on a farm, but denies exposure to farm animals or birds. >She is married and does not work outside the home. >Obstetrical history is remarkable only for 3 spontaneous vaginal >deliveries at term without complication. > >Physical examination notes a non-toxic appearing well developed and >well nourished appearing female. >VS 96/60 pulse 120 Temp 102.9 RR 20 99% sat on RA >Only pertinent postives on exam are mild tenderness to palpation of the liver >and a grade 1-2/6 systolic flow murmur at the aortic site. >Pertinent negatives incluse the lack of scleral icterus, normal >oropharynx, no cervical lymphadenopathy, clear lungs, soft abdomen with >normoactive bowel sounds, no CVAT, normal pelvic exam with a 12-14 wk uterus >which is non-tender, and the absolute lack of any skin lesion. > >Lab Data: > >Heme: H/H: 10/33 (on 10/3) which decreased to 8/24 (on 10/27) > MCV 85 WBC ct 4.6 with diff 59 segs, 37 lymphs, and 0 eos >PT/PTT 12/32 (nl) UA only sig for 2+ protein >Chemistries: Creatinine 0.6 K 3.7 Alb2.7 ALT/ST elevated 123/122 > LDH 458 Amylase 241 >Serologies: HBsAg(-) HBsAb(-) anti-HBc(-) anti-HAV IgM(-) anti-HCV(-) > HIV(-) RPR 1:2 MHATP NR Rubella Immune >Blood type O positive. Genital cultures negative for GC and Chl > >Pending labs: ANA, CMV IgG and IgM, 24 hour urine for protein, PPD, > Cultures of blood, urine, feces, and oral cavity for bacteria and > viruses, smear for malaria, and brucellosis titers. > >Chest xray was negative except for mild thoracic scoliosis. >RUQ U/S pending > >She spiked to 104 last night, but does not feel unwell... > >Thanks for any help you can give.. >(maybe if the answer is a good zebra, Dr. Nagey will let me present it >at stump the professor......)
Diagnosis: Leptospirosis
suggest leptospira titres and organism culture.
treatment: fluid hydration and penicillin
differential diagnosis: fatty liver of pregnancy, Infectious mononucleosis,
viral hepatitis.
>Geff Klein, MD Baylor College of Medicine, Dept OB-GYN Dr. Carlos Chase Bridgetown Barbados "Sun, sea and sand in the Caribbean" E-mail: drchase@caribnet.net
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