Medical Mystery: A 46-year old woman with prolonged fever
A 46-year-old woman was hospitalized due to fever of up to 39°C of one week’s duration. The patient complained of weakness, night sweats, and weight loss for two weeks prior to admission. The patient had no past medical history, and did not take any medications, supplements, or illicit drugs. She was born and lived all her life in a rural village. She was indirectly exposed to farm animals and pets, yet had no close contact with these, and her family was not engaged in agricultural work. She denied having been bitten by ticks or fleas. There was no history of recent foreign travel or eating raw meat or unpasteurized milk. She reported no rashes, arthralgia, dryness of eyes, mouth ulcers, or mucocutaneous bleeding. On examination she appeared pale and sweaty. The cardiorespiratory examination was unremarkable. A markedly tender and enlarged liver and spleen, 3 cm and 10 cm below the costal margins, respectively, were noted, with no palpable lymph nodes. Periorbital and peripheral extremity edema was also present. What are likely etiologies for this patient’s high fever and organomegaly?
Tags: Biology, Emerging disease, Health, Medicine, Microbiology
EBV.
Good guess, but not correct :-)
TB
TB not a bad guess, but also wrong in this case.
I think that was a silly guess.
I don’t know much about the liver…. other than it’s connection to alcohol
Based on the symptoms and micrograph I going with Listeriosis with no gastrointestinal involvement???
Another good try … but also incorrect.
You all need to think a bit more … exotic ;-)
Take two:
Rural area with farms could mean a plethora of cute furry animals running about- Hanta-(although she would be dead by now), Tularemia, or plague perhaps?
Visceral Leishmaniasis…Isnt that mostly in the Middle East though? I didn’t realize that histo-section read ‘bone marrow’ when you move the cursor over it-
Yes, the case description is from Israel.
Admittedly, I grew frustrated and had to google ‘bone marrow’ ‘spenomegaly’ and ‘fever’. Once I saw VL, I figured that was it if the location fit.
Good time though, and I learned a little something too. I will do better for the next one!
Thank you for the case.
ET