1/10. fever of unknown origin.This is a case study of a 26-year-old Hispanic male who presented with an initial complaint of fevers, chills and generalized weakness for three weeks. Patient reported a classical history of diurnal fever with temperature spikes as high as 105.8F after returning from a trip to guatemala. His symptoms had waxed and waned for 3 weeks. This case study will focus on the initial presentation, value of complete history and physical exam, use of laboratory data and use of specialized diagnostic procedures in the outpatient setting. This case proves to be highly relevant to primary care in the context of treating patients with fevers of unknown etiology. Primary care physicians should be alert for unusual diseases in patients who are returning from foreign travel. malaria is a potentially fatal disease that can be acquired by travelers to certain areas of the world, primarily developing nations. Transmitted through the bite of the anopheles mosquito, malaria usually presents with fever and a vague systemic illness. The disease is diagnosed by demonstration of plasmodium organisms on a specially prepared blood film. This case study speaks to the importance of prompt work up and treatment of fever of unknown origin that presents in an unusual clinical picture or that is not readily explainable.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. Evaluating postoperative fever: a focused approach.Postoperative fever should be evaluated with a focused approach rather than in "shotgun" fashion. Most fevers that develop within the first 48 hours after surgery are benign and self-limiting. However, it is critical that physicians who provide postoperative care be able to recognize the minority of fevers that demand immediate attention, based on the patient's history, a targeted physical examination, and further studies if appropriate. Fever that develops after the first 2 days following surgery is more likely to have an infectious cause, but noninfectious causes that require further evaluation and treatment must also be considered. When evaluating postoperative fever, a helpful mnemonic is the "four Ws": wind (pulmonary causes: pneumonia, aspiration, and pulmonary embolism, but not atelectasis), water (urinary tract infection), wound (surgical site infection), "what did we do?" (iatrogenic causes: drug fever, blood product reaction, infections related to intravenous lines).- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. Imaging infection with 18F-FDG-labeled leukocyte PET/CT: initial experience in 21 patients.The aim of this study was to assess the feasibility and the potential role of PET/CT with (18)F-FDG-labeled autologous leukocytes in the diagnosis and localization of infectious lesions. methods: Twenty-one consecutive patients with suspected or documented infection were prospectively evaluated with whole-body PET/CT 3 h after injection of autologous (18)F-FDG-labeled leukocytes. Two experienced nuclear medicine physicians who were unaware of the clinical end-diagnosis reviewed all PET/CT studies. A visual score (0-3)-according to uptake intensity-was used to assess studies. The results of PET/CT with (18)F-FDG-labeled white blood cell ((18)F-FDG-WBC) assessment were compared with histologic or biologic diagnosis in 15 patients and with clinical end-diagnosis after complete clinical work-up in 6 patients. RESULTS: Nine patients had fever of unknown etiology, 6 patients had documented infection but with unknown extension of the infectious disease, 4 patients had a documented infection with unfavorable evolution, and 2 patients had a documented infection with known extension. The best trade-off between sensitivity and specificity was obtained when a visual score of >or=2 was chosen to identify increased tracer uptake as infection. With this threshold, sensitivity, specificity, and accuracy were each 86% on a patient-per-patient basis and 91%, 85%, and 90% on a lesion-per-lesion basis. In this small group of patients, the absence of areas with increased WBC uptake on WBC PET/CT had a 100% negative predictive value. CONCLUSION: Hybrid (18)F-FDG-WBC PET/CT was found to have a high sensitivity and specificity for the diagnosis of infection. It located infectious lesions with a high precision. In this small series, absence of areas with increased uptake virtually ruled out the presence of infection. (18)F-FDG-WBC PET/CT for infection detection deserves further investigation in a larger prospective series.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. Numb chin syndrome: a case report.Neuropathy of the inferior alveolar nerve is common in dental practice. Its cause, when not a result of local anesthetic, is normally from dental disease or trauma. Isolated mental neuropathy (numb chin syndrome) is extremely uncommon, and its most common cause also is dental. The next most common cause is from an underlying neoplasm, and some cases have resulted from systemic disease (eg, multiple sclerosis). Some patients show no evidence of additional disease and experience spontaneous remission of the symptom. Numb chin syndrome cases require coordination of treatment between dentists and physicians. Since a disproportionate number of these cases present with a numb chin as the first symptom of a neoplasm, aggressive diagnosis is required. Careful follow up is important before dismissing it as a spontaneous remission. dentists must be familiar with isolated mental neuropathy and its medical implications because they are likely to be the first health professionals that patients present to for diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. vancomycin allergy presenting as fever of unknown origin.A 37-year-old woman receiving long-term hemodialysis was admitted to the hospital with a fever of unknown origin (6 weeks of unexplained, persistent, low-grade fever). Although she had received vancomycin hydrochloride 5 days before the onset of fever, the drug was not suspected as the cause because of the duration of fever, the administration of vancomycin on prior occasions without incident, and the lack of allergic stigmata. After hospitalization, vancomycin and gentamicin sulfate were administered empirically. Immediately thereafter, her temperature rose to 40 degrees C, and over the ensuing 24 hours, eosinophilia and a maculopapular rash developed that resolved entirely when antibiotic therapy was stopped and low-dose steroid therapy was instituted. The prolonged hypersensitivity reaction after a single dose of vancomycin is consistent with the greatly extended half-life of this drug in the population with end-stage renal disease and should alert physicians to the possibility of such persistent idiosyncratic reactions in this group.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. Incidental diagnosis of pregnancy on bone and gallium scintigraphy.Bone and gallium scintigraphy were performed as part of the diagnostic workup of a 21-yr-old woman who presented at our institution with a history of progressively worsening low back pain over a 1-wk period of time. The angiographic phase of the bone scan demonstrated a well-defined radionuclide blush within the pelvis just cephalad to the urinary bladder with persistent hyperemia noted in the blood-pool image. We attribute these findings to a uterine blush secondary to the pronounced uterine muscular hyperplasia, hyperemia, and edema that accompany pregnancy. gallium scintigraphy demonstrated intense bilateral breast accumulation of the imaging agent in a typical doughnut pattern which is commonly found in the prelactating and lactating breast. Also demonstrated was apparent gallium accumulation in the placenta. This case is presented to emphasize the radionuclide findings that occur during pregnancy, particularly the incidental finding of radionuclide blush during the angiographic phase of a radionuclide scintigraphy which should alert the nuclear physician to the possibility of pregnancy in a woman of childbearing age.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. tuberculosis presenting as puerperal fever.Two cases of unusual postpartum fever in foreign nationals are presented. Prolonged work-up led to the diagnosis of pulmonary tuberculosis as a cause of postpartum fever that responded well to antituberculous drugs. The signs and symptoms illustrated by these cases should alert physicians to consider tuberculosis in their differential diagnosis when caring for pregnant immigrants. The changing patterns and diagnostic and therapeutic problems are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. brucella canis: an infectious cause of prolonged fever of undetermined origin.We have reported a case documenting the difficulties encountered in diagnosing and treating patients with brucellosis caused by brucella canis, including the nonspecific clinical presentation, low level of intermittent bacteremias, the slow-growing, fastidious nature of the organism, and the lack of antigenic cross-reactivity with the antigens usually used in routine Brucella serology. Further, the predominant southeastern united states epidemiology of this organism and the importance of exposure to dogs are also demonstrated by this report. It is important that physicians caring for patients in this region of the country be aware of the epidemiologic, serologic, and microbiologic pitfalls encountered in diagnosing B canis infections.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. The role of dental disease in fever of unknown origin.The case presented emphasizes the need for evaluation of the oral cavity in the diagnostic workup of fever of unknown origin. Hurley stated, "Protracted fever of obscure cause remains one of the more daunting clinical challenges facing the physician. It calls for mobilization of all the physician's own skills and the expertise of colleagues as well as maintenance of an open mind to the patient's complaints and observations. Dogged determination and a systematic approach are the keys to solving the problem." When the possibility of dental disease is overlooked, the resulting search is sometimes long, tedious, and expensive. Early examination of the oral cavity by qualified personnel should be done even though pain is not present.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
10/10. fever of unknown origin: diagnostic principles.Almost by definition, diagnostic evaluation of a patient with fever of unknown origin remains a challenging problem. Before turning to lengthy checklists and a battery of sophisticated invasive procedures, the physician should pursue all possibilities suggested by the patient's clinical and epidemiologic history. Four illustrative cases are presented to exemplify this logical approach.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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