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Gastrointestinal system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
6.13. In Crohn's disease of childhoodthe stomach and duodenum may be involved.diarrhoea with blood and mucus is a characteristic early symptom.growth retardation is a characteristic feature.surgical resection of the affected gut is curative.fever of unknown origin may be the presenting symptom.
Tuberculosis in Childhood and Pregnancy
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Lindsay H. Cameron, Jeffrey R. Starke
The early diagnosis of disseminated tuberculosis can be difficult, requiring a high index of suspicion by the clinician. Often the patient presents with fever of unknown origin. Mycobacterial blood cultures are rarely, if ever, positive. Early sputum or gastric aspirate cultures have a low sensitivity. Biopsy of the liver or bone marrow are the best methods to attempt to establish an early diagnosis.
Miscellaneous procedures
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
99mTc-HMPAO-labelled WBC scintigraphy may be used to detect and localise suspected sites of infection/inflammation with or without localising symptoms. Common indications include: Fever of unknown origin.Osteomyelitis of the appendicular skeleton.Infected joint and vascular prosthesis.Diabetic foot.Post-operative abscesses.Lung infections.Inflammatory or ischaemic bowel disease.
Fatal epidural abscess with meningitis: a rare complication of colorectal surgery
Published in Acta Chirurgica Belgica, 2021
Elodie Gaignard, Damien Bergeat, David Kieser, Fabien Robin, Bernard Meunier
Several cases of epidural abscess and meningitis caused by abdominal sepsis have been described in the literature in the setting of Crohn’s disease [4,5], appendicitis [6], duodenal ulcer [7] and colorectal surgery [8]. These infections are developed after the introduction of bacteria into the sterile epidural space. Most commonly, this occurs from haematogenous seeding from an anatomically distanced source, such as endocarditis, infected catheters, soft tissue, urinary or respiratory infections. More rarely, bacteria enter in the epidural space by direct extension of infected tissue, which was the case reported here. The ensuing symptoms vary from fever of unknown origin, to axial back pain or neurological dysfunction. Epidural abscess complicating AL is rarely mentioned in a context of fever after colorectal surgery, yet the prognosis is affected by the severity of the infection, which itself is affected by the time to diagnosis. Thus, a delay in diagnosing and treating this complication, because of a lack of awareness of this complication, may result in permanent neurological dysfunction, sepsis and death. This was the case in our patient who experienced 4 months of low-grade fever and failure to thrive before decompensating into septic shock. Only at this stage, the classic triad of back pain, fever and neurologic dysfunction was recognised.
National survey of Japanese patients with mevalonate kinase deficiency reveals distinctive genetic and clinical characteristics
Published in Modern Rheumatology, 2019
Takayuki Tanaka, Kohei Yoshioka, Ryuta Nishikomori, Hidemasa Sakai, Junya Abe, Yuriko Yamashita, Ryugo Hiramoto, Akira Morimoto, Eiichi Ishii, Hirokazu Arakawa, Utako Kaneko, Yusei Ohshima, Nami Okamoto, Osamu Ohara, Ikue Hata, Yosuke Shigematsu, Tomoki Kawai, Takahiro Yasumi, Toshio Heike
Four of the ten patients had elevated transaminases (Table 2). Of note, in two patients, transaminase elevation preceded onset of periodic fever (Patients 1 and 2). Patient 1 presented with neonatal-onset chronic hepatitis and increased CRP levels [9]. Persistent elevation of serum transaminase levels, serum IgG, and anti-smooth muscle antibodies led to a diagnosis of autoimmune hepatitis at the age of 14 months. Treatment with prednisolone and azathioprine normalized serum transaminase levels. From the age of 32 months, the patient experienced periodic fever accompanied by maculopapular rashes. Based on the genetic and laboratory results, a diagnosis of MKD was established at the age of 6 years. At birth, Patient 2 presented with hydrops fetalis, respiratory distress syndrome, anemia, and pulmonary artery stenosis. Serum transaminase levels fell gradually without specific treatment. The patient was admitted to hospital with fever of unknown origin aged 1 year. The fever was accompanied by elevated serum transaminase levels (AST, 1321 U/L; ALT, 1602 U/L). Transaminase levels normalized again without specific treatment and remained within the normal range thereafter. The patient started to experience recurrent febrile attacks aged 6 years and was diagnosed with MKD.
Murine typhus
Published in Baylor University Medical Center Proceedings, 2022
Seamus Lonergan, Gowtham Ganesan, Stephen J. Titus, Kashif Waqiee Ahmed
Fever of unknown origin is defined as a fever >38.3°C with a duration of at least 3 weeks and an uncertain diagnosis after 1 week of study in the hospital.1 This creates a diagnostic and clinical dilemma in the evaluation of patients suffering from febrile symptoms that are longer than a typical self-limited disease course, but yet less than the 3-week threshold. We present a case of murine typhus that fell into this category and highlights the importance of a thorough history and physical, which aid in creating a targeted diagnostic approach.