11/58. Thoracic myelopathy complicating acute meningococcal meningitis: MRI findings.spinal cord dysfunction is a rare complication of neisseria meningitidis (meningococcal) meningitis. We report a 17-year-old patient who had a 3-day history of fever, headache and vomiting, agitation, and unresponsiveness. cerebrospinal fluid showed a marked polymorphonuclear pleocytosis. latex particle agglutination was positive for meningococci. The patient was given intravenous antibiotics and intravenous dexamethasone. Over the next 4 days, he developed weakness of the lower extremities, with areflexia and extensor plantar responses. MRI revealed contiguous hyperintensities on T2-weighted images involving the thoracic spinal cord from T4 to T9 and 4 brain abscesses. Five months later, he recovered brain function, but the paraparesis remained. This case illustrates that myelopathy may complicate acute meningococcal meningitis, possibly due to a vasculitis, stroke, autoimmune myelopathy, or direct infection of the spinal cord. patients with myelopathy associated with acute meningitis should receive spinal MRI. In addition, meningitis should be considered in patients presenting with acute myelopathy.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
12/58. An unknown autoinflammatory syndrome associated with short stature and dysmorphic features in a young boy.A young boy from nonconsanguineous Palestinian parents presented with short stature, motor developmental delay, wide nasal bridge, bilateral periorbital edema, everted lower lip, brachydactyly, large interphalangeal articulations, drumstick extremities of the fingers, bilateral simian crease, clinodactyly of the 5th fingers, painful joints, subcutaneous nodules all over his body and recurrent episodes of fever of unknown origin. Differential diagnoses such as the hyperimmunoglobulinemia D syndrome, tumor necrosis factor receptor associated periodic syndrome (TRAPS), the chronic infantile neurological cutaneous and articular (CINCA) syndrome, and the newly recognized nodulosis, arthropathy, and osteolysis (NAO) syndrome are discussed. This syndrome may not have been previously reported.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
13/58. Report of eight infants with acute infantile hemorrhagic edema and review of the literature.Acute infantile hemorrhagic edema (AIHE) is a cutaneous leukocytoclastic vasculitis, clinically characterized by the symptom triad of fever, large purpuric skin lesions, and edema. The clinical picture has a violent onset, a short benign course, and spontaneous complete recovery. In this article, we present eight patients who were admitted with rashes on the skin and edema on the eyelids and extremities, and were diagnosed with AIHE according to their clinical and histopathological features (immunohistological study was also performed in three of them). Our purpose was to emphasize that, aside from Henoch-Schonlein purpura, meningococcemia, septicemia, and purpura fulminans, AIHE benign disorder should also be considered in the differential diagnosis to determine the clinical course and treatment protocol in patients with purpuric rashes.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
14/58. Remitting seronegative symmetrical synovitis with pitting oedema: a study of 12 cases.Twelve patients with remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) were analysed. Eight of them had typical RS3PE without underlying disease, and four presented associated neoplasia. The first patients experienced an excellent response to low doses of prednisone, and they all achieved complete and permanent remission. The mean treatment duration was 18 months and the mean follow-up was 4.4 years. During the follow-up, none of these patients relapsed, had fever or general health deterioration, and hand and foot radiographs did not show erosion. One of them developed a panarteritis nodosa 6 years later. Four RS3PE patients had associated neoplasia. Two were with solid malignancies, and the other two presented haematological malignancies. In one of them RS3PE preceded the diagnosis of malignancy. The diagnosis of RS3PE in the other patients was subsequent to cancer. The first patients presented clinical characteristics suggestive of paraneoplastic RS3PE, and they had a poor response to corticosteroid therapy. Two patients died, and the rest of them had a complete response to surgical resection of the tumour or to chemotherapy. In general, idiopathic RS3PE patients do not show either general health deterioration or fever and they do respond to low doses of steroids (10 mg/day). We observed strong contrasts with the results obtained when treating RS3PE patients with associated neoplasia. In patients with RS3PE the presence of systemic symptoms along with resistance to low doses of corticosteroid therapy should alert the physician to the possible presence of malignancy.- - - - - - - - - - ranking = 2keywords = fever (Clic here for more details about this article) |
15/58. Epstein-Barr virus-associated T-cell lymphoma: a case of eyelid swelling and intramuscular infiltration mimicking dermatomyositis.association with Epstein-Barr virus (EBV) infection has been noted in various types of cutaneous lymphoproliferative disorders. We report a 57-year-old Japanese woman with T-cell lymphoma mimicking dermatomyositis that was associated with chronic active EBV infection. She presented with low-grade fever, bilateral erythematous swellings on the eyelids, and necrotic papules on the face. serum creatine kinase levels were elevated and a diffuse reticular shadow was detected in both lung fields. The infiltrate of atypical lymphocytes found in skin and muscle, which contained EBV-encoded small nuclear rna-1 and EBV, was also detected in the CD4 peripheral blood cells. Treatment with prednisolone resolved her lesions with no relapse for 3 years, after which there was a recurrence in her left lung. Combination chemotherapy was not effective against the lung lesion and she died with multiple organ failure 2 months after the recurrence.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
16/58. Recurrent cutaneous erythralgia and arthralgia.Two cases are reported of Vietnamese men who presented in young adult life with recurrent, painful, erythematous patches (which we have termed "erythralgia") over and adjacent to joints and accompanied by marked constitutional symptoms of malaise and lethargy, arthralgia and in one patient, fever. In the other, from the onset of the disease there were nodules over the bony prominences and in the interphalangeal regions of the fingers. The duration of the disease was over 12 years, the duration of each episode without therapy was one week and the interval between episodes was one to two weeks. In addition the patients showed a raised ESR and peripheral neutrophil leucocytosis of over 70%. There was a rapid response, within hours, to non-steroidal anti-inflammatory agents. skin biopsies taken at varying stages of the disease episode failed to demonstrate neutrophils thereby failing to satisfy one major criterion of Sweet's syndrome. Direct immunofluorescence studies were negative. biopsy of the nodules did not show rheumatoid pathology. The serum rheumatoid factor was negative. Investigations failed to demonstrate any recognised pattern of cutaneous or rheumatologic disease; infections such as borreliosis were excluded. Both patients showed evidence of past hepatitis b infection. As recurrent painful cutaneous erythema is an uncommon phenomenon in dermatology except where the patient is suffering from recurrent cellulitis of the lower limbs, the patients reported here exhibit a pattern of disease not previously described.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
17/58. Chronic active Epstein-Barr virus infection in an adult.We report a rare adult case of chronic active Epstein-Barr virus (EBV) infection. A 54-year-old woman was admitted to our hospital with intermittent fever, weight loss, hepatosplenomegaly, pancytopenia and liver disturbance. In serological tests for EBV, anti-virus capsid antigen (VCA)-IgG antibody and anti-early antigen (EA)-IgG antibody were markedly elevated and anti-EBV nuclear antigen (EBNA) antibody was negative. EBV genome was detected in the bone marrow nucleated cells and peripheral lymphocytes by Southern blot hybridization. The patient developed left facial edema, bilateral breast tumor and pneumonia. She died one year after admission in spite of the administration of prednisolone, interferon and acyclovir.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
18/58. gastric outlet obstruction by an antral mucosal diaphragm: a case of a congenital anomaly revealed by an acquired disease.Congenital antral membrane may become symptomatic early in life or late in childhood. A gastric outlet obstruction was revealed in a 14-month-old girl, previously developing well until 3 days ago, by melaena and recurrent non-bilious vomiting, after administration of a non-steroidal anti-inflammatory drug for fever. Plain X-ray performed during the neonatal period was normal. Despite ultrasonography, contrast radiography and endoscopy, the correct diagnosis was made at surgery; the obstruction was due to an inflammatory, thickened membrane with mucosal oedema reducing the central aperture of the diaphragm. This case emphasizes that if antral membrane diaphragm is congenital, the onset of symptoms may result from an additional acquired lesion.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
19/58. rocky mountain spotted fever as a cause of macular star figure.An 86-year-old woman with a history of tick bites in the previous months developed subnormal visual acuity in both eyes, keratic precipitates, anterior chamber and vitreous cells, optic disc edema, retinal hemorrhages, and retinal arteriolar sheathing. She had no fever or skin rash. Three weeks later, binocular macular star figures appeared. brain imaging was negative; cerebrospinal fluid disclosed a lymphocytic pleocytosis and elevated protein. The serum rickettsia rickettsii antibody test was markedly positive, establishing a diagnosis of rocky mountain spotted fever (RMSF) as the cause of the ophthalmic findings. Despite treatment with oral doxycycline, these findings improved only modestly. Although neuroretinitis has been previously described in RMSF, macular star has not been documented.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
20/58. Drug-induced eosinophilia and multisystemic failure with positive patch-test reaction to spironolactone: DRESS syndrome.We report the case of a 58-year-old man who suffered from a generalized and intolerable itching one month after starting treatment with colchicine, amiodarone, perindopril, allopurinol and spironolactone. From the start of treatment he had progressively developed erythroderma, fever, anorexia and prostration, oedema of both hands and face, hypereosinophilia (42%; 5810 eosinophils/mm3), hepatic failure (including cholestatic jaundice, cytolysis, coagulation abnormalities and hypoproteinaemia), exocrine pancreatic failure (with severe steatorrhoea), renal failure, metabolic acidosis, aggravation of pre-existing cardiac insufficiency and oedema of the lower extremities. All medications were stopped and the condition improved slowly until complete remission was reached 4 months later. Patch-testing was performed, including the various drugs. All the tests (including components of the vehicles) were negative, except for spironolactone, which gave a strong positive reaction. Ten controls in healthy volunteers were negative. The diagnosis of drug rash with eosinophilia and systemic symptoms (DRESS) induced by spironolactone was made. This is the first report of DRESS due to spironolactone.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
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