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Unexplained Fever In Hematologic Disorders Section 1. Benign Hematologic Disorders
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
In paroxysmal nocturnal hemoglobinuria (PNH), which is an acquired disorder of the red blood cell membrane, an abnormal complement-sensitive clone is present; leukopenia and thrombocytopenia are also frequently observed. Typically, there is hemosiderinuria and the leukocyte alkaline phosphatase (LAP) score is reduced. Demonstration of complement sensitivity (Ham test) and of reduced activity of acetylcholinesterase in the RBC will establish the diagnosis. Patients with PNH are prone to thromboembolic disease. Occasionally, the disease may evolve into acute leukemia. Both these conditions may be considered in a patient with PNH and continuous fever.
Epidemics and State Medicine in Fifteenth-Century Milan
Published in Roger French, Jon Arrizabalaga, Andrew Cunningham, Luis García-Ballester, Medicine from the Black Death to the French Disease, 2019
Bubonic plague presented an anomaly to medical authorities. On the one hand it was clearly associated with a continuous fever that could not also be characterized as hectic (involving the solid parts), ephemeral (involving the spirits) or putrid (involving the humours). Pestilential fevers came from breathing corrupted air, which generated excess heat in the heart and surrounding region, suppressing the vital spirit.20 On the other hand, buboes were a dramatic clinical feature in epidemics of plague, and buboes were understood usually with the term 'aposteme'. Unfortunately buboes and pestilential fevers could have different etiologies.
An unusual cause of “traumatic” hemothorax: perforation of the lung parenchyma by a bifid rib
Published in Acta Chirurgica Belgica, 2020
Sander Ovaere, Anneleen Peeters, Lieven Depypere
First line treatment at the referring center consisted of successful transthoracic drainage as 1.5 liter of bloody fluid was drained and the patient was discharged two days later in good clinical condition. Two days later, the patient returned to the outpatient clinic with symptoms of fever, fatigue and dyspnea. His CRP level had risen to 156 mg/L (normal <5 mg/L). Computed tomography showed the recurrent presence of fluid and atelectasis of the right lower lung (Figure 1). A diagnostic puncture showed an exsudate without any signs of empyema. The patient was admitted to the hospital and broad-spectrum antibiotics were started. Because of the worsening fatigue, continuous fever (38 °C), tachycardia to 140 bpm, in combination with a rise of CRP to 200 mg/L, the patient was referred to our center for surgical intervention.
Non-infectious Fever After Acute Spinal Cord Injury in the Intensive Care Unit
Published in The Journal of Spinal Cord Medicine, 2019
Fatma Ülger, Mehtap Pehlivanlar Küçük, Çağatay Erman Öztürk, İskender Aksoy, Ahmet Oğuzhan Küçük, Naci Murat
Fever was defined in intensive care patients as body temperature of ≥ 38.0°C on at least one measurement during two consecutive days. The number of consecutive days over which this threshold value was exceeded was defined as the "duration of fever". Only patients with persistent fever were included in this study. “Persistent fever” was defined as continuous fever for more than 6 h over 2 or more consecutive days. All patients were followed for the duration of intensive care treatment. The first febrile episodes in this phase were evaluated according to their probable etiology. A febrile episode was defined as three consecutive days without fever. For the patients included in this study, the first day of fever detection, the duration of fever, the highest measured body temperature, and whether the fever was responsive to antipyretic-antibiotherapy and external cooling were documented on daily nursing vital sign ‘charts. The body temperature was measured continuously using axillary and tympanic probes and recorded on an hourly basis. Fever was treated with acetaminophen, metamizole, and external cooling (cooling blankets, ice packs).
Clinical practice guidance for juvenile idiopathic arthritis (JIA) 2018
Published in Modern Rheumatology, 2019
Nami Okamoto, Shumpei Yokota, Syuji Takei, Yuka Okura, Tomohiro Kubota, Masaki Shimizu, Tomo Nozawa, Naomi Iwata, Hiroaki Umebayashi, Noriko Kinjo, Tomoko Kunishima, Junko Yasumura, Masaaki Mori
Delay in therapeutic intervention against MAS may result in a life-threatening condition. Thus, if this clinical condition is suspected, it is crucial to consult with pediatric rheumatologists immediately in order to start treatments. MAS has recently been proposed to occur in systemic JIA triggered by complications due to viral infection and the use of certain drugs including NSAIDs. 2016 classification criteria for MAS complicating sJIA were recently proposed [72,73] as shown in Table 9. Once MAS develops, fever patterns change, suddenly leading to continuous fever and hepatosplenomegaly. Hemorrhagic symptoms and respiratory distress are sometimes observed. The characteristic findings of MAS are leukocytopenia, thrombocytopenia, coagulation disorders such as fibrinogen decrease, FDPs, and D dimer increase, liver enzyme increase, elevated triglycerides, and abnormally high ferritin levels. These abnormal findings are closely associated with overproduction of inflammatory cytokines. Thus, monitoring the concentration of proteins induced by these cytokines is useful in understanding the pathophysiology of MAS (Figure 7).