scholarly journals Multiple Intracardiac Masses as the Primary Presentation of a Systemic Inflammatory Disease: A Big Challenge (Case Report)

2021 ◽  
Author(s):  
Zahra Khalaji ◽  
Bahar Galeshi ◽  
simin almasi ◽  
Mozhgan Parsaee ◽  
Hamidreza Pouraliakbar
Keyword(s):  
Arterial Thrombosis ◽  
Fever Of Unknown Origin ◽  
Inflammatory Diseases ◽  
Clinical Manifestations ◽  
Unknown Origin ◽  
Pregnancy Morbidity ◽  
Systemic Inflammatory Disease ◽  
Intracardiac Masses ◽  
Primary Presentation ◽  
Intracardiac Thrombi

Antiphospholipid syndrome (APS) classically presents with venous or arterial thrombosis and pregnancy morbidity. Although clinical manifestations with fever of unknown origin and intracardiac masses are unusual, in a patient with prolonged fever and multiple intracardiac thrombi, systemic inflammatory diseases such as APS should be considered.

scholarly journals Arterial thrombosis as primary presentation of endogenous Cushing’s syndrome

2019 ◽  
Vol 12 (2) ◽  
pp. bcr-2018-227491
Author(s):  
Vijay Alexander ◽  
Maria Koshy ◽  
Riddhi Dasgupta ◽  
Ronald Albert Carey
Keyword(s):  
Cushing’S Syndrome ◽  
Arterial Thrombosis ◽  
Clinical Manifestations ◽  
Dynamic Mri ◽  
Cushing's Syndrome ◽  
Positron Emission ◽  
History Of ◽  
Laboratory Investigations ◽  
Primary Presentation

Cushing’s syndrome is known to present with a characteristic set of clinical manifestations and complications, well described in literature. However, hypercoagulability remains an under recognised entity in Cushing’s syndrome. A 31-year-old woman from Southern India presented with history of fever, left upper quadrant pain and progressive breathing difficulty for 3 weeks. Clinical examination revealed discriminatory features of Cushing’s syndrome. Laboratory investigations showed biochemical features of endogenous ACTH-dependent Cushing’s syndrome. Imaging of the abdomen revealed splenic collection, left-sided empyema and extensive arterial thrombosis. Gadolinium enhanced dynamic MRI of the pituitary gland revealed no evidence of an adenoma while a Ga-68 DOTATATE positron emission tomography CT scan ruled out an ectopic Cushing’s. A diagnosis of endogenous Cushing’s syndrome causing a prothrombotic state with extensive arterial thrombosis was made. She was initiated on oral anticoagulation and oral ketoconazole for medical adrenal suppression. She subsequently underwent bilateral adrenalectomy and was well at follow-up.

scholarly journals Diagnostic Use of Serum Ferritin Levels to Differentiate Infectious and Noninfectious Diseases in Patients with Fever of Unknown Origin

2013 ◽  
Vol 34 (3) ◽  
pp. 211-218 ◽  
Author(s):  
Seong Eun Kim ◽  
Uh Jin Kim ◽  
Mi Ok Jang ◽  
Seung Ji Kang ◽  
Hee Chang Jang ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Serum Ferritin ◽  
Fever Of Unknown Origin ◽  
Inflammatory Diseases ◽  
Unknown Origin ◽  
University Hospital ◽  
Disease Group ◽  
Hematologic Disease ◽  
Hematologic Diseases

INTRODUCTION: In this study, we determined whether serum ferritin levels could be used to differentiate between fever of unknown origin (FUO) caused by infectious and noninfectious diseases.METHODS: FUO patients were hospitalized at Chonnam National University Hospital between January, 2005 and December, 2011. According to the final diagnoses, five causes were identified, including infectious diseases, hematologic diseases, noninfectious inflammatory diseases, miscellaneous and undiagnosed.RESULTS: Of the 77 patients, 11 were caused by infectious diseases, 13 by hematologic diseases, 20 by noninfectious inflammatory diseases, 8 by miscellaneous diseases, and 25 were undiagnosed. The median serum ferritin levels in infectious diseases was lower than those in hematologic diseases and (median (interquartile range) of 282.4 (149.0–951.8) ng/mL for the infectious disease group, 1818.2 (485.4–4789.5) ng/mL for the hematologic disease group, and 563.7 (399.6–1927.2) ng/mL for the noninfectious inflammatory disease group,p= 0.048, Kruskal–Wallis test). By comparison using the Mann–Whitney test, statistically significant differences were found only between the infectious disease and hematologic disease groups (p= 0.049) and between the infectious disease and groups (p= 0.04).CONCLUSION: An optimal cutoff value of serum ferritin levels to predict FUO caused by a noninfectious disease (hematologic diseases, noninfectious inflammatory diseases) was established as 561 ng/mL.

scholarly journals Clinical course of coxsackievirus B (1-6) infection

2020 ◽  
Vol 17 (1) ◽  
pp. 3-7
Author(s):  
Slađana Pavić ◽  
Marija Antić ◽  
Radmila Sparić ◽  
Aleksandra Pavić
Keyword(s):  
Aseptic Meningitis ◽  
Fever Of Unknown Origin ◽  
Antinuclear Antibodies ◽  
Clinical Course ◽  
Acute Myocarditis ◽  
Clinical Manifestations ◽  
Unknown Origin ◽  
Coxsackievirus B ◽  
Virus Serotype ◽  
Febrile Condition

Objective. Coxsackievirus B (1-6) infections are the common infections of children and adults. Clinical manifestations include fever, aseptic meningitis, pleurodinia, myocarditis, gastroenterocolitis, maculous exanthem. The clinical course of the infection is influenced by the characteristics of the host, as well as the virus serotype. The pathogenesis of the diseases is explained by the immune mediated mechanism and the direct cytotoxic effect of the virus. Methods. Retrospectively analyzed virus serotype, clinical and biochemical data in patients with coxsackievirus B (1-6) infection. Patients who had an unclear febrile condition for more than six months were tested for autoantibodies. Results. We examined a total of 378 patients with coxsackievirus B (1-6) infection (302 women, 76 men), age 19 to 79 years. The dominant symptoms were weakness, elevated body temperature, fatigue and muscle aches. In 55% the clinical course was fever of unknown origin, in 13% myalgia/pleurodinia, 9% acute gastroenterocolitis and acute myocarditis/ pericarditis, 2% aseptic meningitis, 2.4% respiratory disease, 3% acute pancreatitis and 1% diabetes mellitus. Autoantibodies were detected in 69% of patients with fever of unknown origin. Antinuclear antibodies were most common, in 67%. Serotype B2 had 36% of these patients. Serotype B2 had 36% of these patients and serotype B4 had 14%. Conclusion. The most common clinical form of coxsackievirus B (1-6) infection is an fever of unknown origin caused by a B2 serotype of the virus. In most of these patients, an elevated titre of antinuclear antibodies can be detected.

scholarly journals Fever of unknown origin in special groups

2019 ◽  
Vol 65 (10) ◽  
pp. 1308-1313
Author(s):  
Leonardo Fernandes e Santana ◽  
Mateus de Sousa Rodrigues ◽  
Marylice Pâmela de Araújo Silva ◽  
Rodrigo José Videres Cordeiro de Brito ◽  
Jandir Mendonça Nicacio ◽  
...  
Keyword(s):  
Physical Examination ◽  
Fever Of Unknown Origin ◽  
Inflammatory Diseases ◽  
Empirical Therapy ◽  
Unknown Origin ◽  
Clinical History ◽  
Outpatient Visits ◽  
Special Groups ◽  
The World ◽  
Detailed Clinical History

SUMMARY Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. It is defined as temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or 3 outpatient visits. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. The initial diagnostic approach of the FUO patient should include non-specific complementary exams. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12-35%, varying according to the baseline etiology.

scholarly journals IgG Autoantibodies againstβ2-Glycoprotein I Complexed with a Lipid Ligand Derived from Oxidized Low-Density Lipoprotein are Associated with Arterial Thrombosis in Antiphospholipid Syndrome

2003 ◽  
Vol 10 (2-4) ◽  
pp. 203-211 ◽  
Author(s):  
Daniel Lopez ◽  
Kazuko Kobayashi ◽  
Joan T. Merrill ◽  
E. Matsuura ◽  
Luis R. Lopez
Keyword(s):  
Venous Thrombosis ◽  
Antiphospholipid Syndrome ◽  
Arterial Thrombosis ◽  
Oxidized Ldl ◽  
Low Density Lipoprotein ◽  
Clinical Manifestations ◽  
Density Lipoprotein ◽  
Healthy Individuals ◽  
Pregnancy Morbidity ◽  
Glycoprotein I

We recently reported [J. Lipid Res.42(2001), 697;43(2002), 1486;44(2003), 716] thatβ2-glycoprotein I (β2GPI) forms complexes with oxidized LDL (oxLDL) and autoantibodies against these complexes are present in patients with SLE and antiphospholipid syndrome (APS). The relationship ofβ2GPI/oxLDL complexes and IgG autoantibodies againstβ2GPI complexed with oxLig-1 (an oxLDL-derived ligand) with clinical manifestations of APS was studied in 150 APS and SLE patients. Theβ2GPI/oxLDL levels of APS patients were similar to those of SLE patients without APS, but they were significantly higher than healthy individuals. There was no difference in the complex levels among the patients with arterial, venous thrombosis, or pregnancy morbidity. IgG anti-β2GPI/oxLig-1 levels of APS were significantly higher than those of SLE without APS and healthy individuals. Further, antibody levels of APS patients with arterial thrombosis were significantly higher than those patients with venous thrombosis and pregnancy morbidity. Thus, oxidation of LDL leads the complex formation withβ2GPI in SLE and APS patients. In contrast, anti-β2GPI/oxLig-1 autoantibodies were generated only in APS and were strongly associated with arterial thrombosis. These results suggest that autoantibodies againstβ2GPI/oxLDL complexes are etiologically important in the development of atherosclerosis in APS.

scholarly journals Adult onset Still’s disease presenting as fever of unknown origin: a case report with review of literature

2017 ◽  
Vol 11 ◽  
Author(s):  
Harpreet Singh ◽  
Deepak Jain ◽  
Saroj Dhankhar ◽  
Rekha Mathur
Keyword(s):  
Joint Pain ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Adult Onset Still’S Disease ◽  
Adult Onset ◽  
Still’S Disease ◽  
Still's Disease ◽  
Rheumatologic Diseases ◽  
Systemic Inflammatory Disease ◽  
Adult Onset Still's Disease

Adult onset Still’s disease (AOSD) is a systemic inflammatory disease with exact etiology and pathogenesis yet to be discovered. AOSD, being an important cause of fever of unknown origin, is diagnosed after ruling out infections, malignancy and other rheumatologic diseases. It may present with fever without typical rash although typical triad is of fever, joint pain and rash. A 35-year old previously healthy man was referred to our hospital with 6 months of fever, joint pain and weight loss. Examination and investigations revealed anaemia, leukocytosis (predominant neutrophilia), lymphadenopathy, hepatomegaly, arthritis and evidence of interstitial lung disease with raised serum ferritin levels. The hematological disorders, infections and other rheumatologic diseases were excluded. The diagnosis of adult onset Still’s disease can be very difficult as there are no specific tests and diagnosis is based on symptom complex. AOSD presenting as fever of unknown origin could be a challenge for the physician to diagnose and manage timely.

scholarly journals Classical Fever of Unknown Origin: Retrospective Study in Infectious Clinical Hospital №2

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S343-S343
Author(s):  
Nikolay Lunchenkov ◽  
Eugene Filippov ◽  
Olga Prihodko ◽  
Elena Volchkova
Keyword(s):  
Infective Endocarditis ◽  
Infectious Diseases ◽  
Bacterial Infection ◽  
Clinical Data ◽  
Fever Of Unknown Origin ◽  
Inflammatory Diseases ◽  
Connective Tissue Diseases ◽  
Unknown Origin ◽  
Axillary Temperature ◽  
Clinical Hospital

Abstract Background Despite the recent advances in medicine, fever of unknown origin (FUO) remains a diagnostic and therapeutic challenge even to expert physicians. The etiological structure of FUO is determined by many factors, including the one where a person lived and where has been hospitalized. The aim of this study is to investigate the etiology and clinical characteristics of adult classical FUO with more diagnostics available and to analyze the factors for certain disease categories. Methods The clinical data were retrospectively analyzed from 80 patients with cFUO hospitalized at the Infectious Clinical Hospital №2 between October 2015 and October 2016 the patients who met the D.Durack criteria (1) An axillary temperature of >38.0 which corresponds oral temperature of >38.3; (2) illness duration is more than 3 weeks; (3) there is no definite diagnosis after three outpatient visits or 3 days in the hospital with intensive investigations; (4) the fever is not related to FUO of other groups: nosocomial FUO, FUO in patients with AIDS, neutropenia were included. Results Of the 80 FUO cases, 70 were positively diagnosed with a diagnosis rate of 87,5%. Infectious diseases were still the primary causes of FUO 63% (n = 50). Among them the most frequent diagnoses were bacterial infection of unspecified site 12.5%
(n = 10), infective endocarditis 11% (n = 9), as well as pneumonia 7.5% (n = 6) and viral infections of unspecified site 7.5% (n=6). Connective tissue diseases and other noninfectious inflammatory diseases accounted for 17.5% of the FUO cases among which SLE and autoimmune thyroiditis were the most common etiologies and made up 5% (n = 4) and 3,75% (n = 3), respectively. Neoplasms were 8% (n = 6) in our sample. Also ten patients (12,5%) could not be confirmed until they were discharged from hospital. Conclusion Infectious diseases are the major causes of FUO, and the most common cause is bacterial infection of unspecified site. To determine the etiology was difficult due to the limited conditions of the clinical hospital. Infectious endocarditis was found on the second place. The most common causative agents of infective endocarditis were MRSA (3/9) и streptococcus viridans (4/9). The frequency of undiagnosed cases was increasing, but in most FUO cases the causes can be diagnosed eventually after careful analysis of clinical data. Disclosures All authors: No reported disclosures.

Fever of Unknown Origin as a Primary Presentation of Chronic Aortic Dissection

Vascular ◽  
2009 ◽  
Vol 17 (4) ◽  
pp. 230-233 ◽  
Author(s):  
Shi-Min Yuan ◽  
Salis Tager ◽  
Ehud Raanani
Keyword(s):  
Aortic Dissection ◽  
Fever Of Unknown Origin ◽  
Pleural Cavity ◽  
Unknown Origin ◽  
Ascending Aorta ◽  
Chronic Type ◽  
Type A Aortic Dissection ◽  
Left Pleural Cavity ◽  
Primary Presentation

Fever of unknown origin is rare as a primary presentation of aortic dissection. We describe a 69-year-old female presenting with a sustained fever. A diagnosis of chronic type A aortic dissection was established by computed tomography. Replacements of the ascending aorta and part of the aortic arch were performed. Ten days after the operation, the patient had recurrent pyrexia. A large effusion in the left pleural cavity was found. After puncture aspiration and antibiotic treatment, she recovered. She was doing well at the 5½-year follow-up.

scholarly journals Chronic Fever with Severe Weakness - A Case Report

2017 ◽  
Vol 25 (2) ◽  
pp. 142-147
Author(s):  
Rabeya Akther ◽  
Humayra Jesmin
Keyword(s):  
Clinical Manifestations ◽  
Hemoglobin Concentration ◽  
Unknown Origin ◽  
Interesting Case ◽  
Differential Diagnoses ◽  
Treatment Modalities ◽  
Unknown Etiology ◽  
Systemic Inflammatory Disease ◽  
Wbc Count ◽  
Severe Weakness

Adult onset Still’s disease (AOSD) is a rare systemic inflammatory disease of unknown etiology and pathogenesis that presents in 5 to 10% of patients as fever of unknown origin (FUO) accompanied by systemic manifestations. We report an interesting case of a 63-year-old Bangladeshi male who presented with one-month duration of FUO along with, severe weakness, oral thrush, high WBC count, low RBC count and low hemoglobin concentration. After extensive workup, potential differential diagnoses were ruled out and the patient was diagnosed with AOSD based on the Yamaguchi criteria. The case history, incidence, pathogenesis, clinical manifestations, differential diagnoses, diagnostic workup, treatment modalities, and prognosis of AOSD are discussed in this case report.J Dhaka Medical College, Vol. 25, No.2, October, 2016, Page 142-147

scholarly journals The Diversity of Juvenile Sarcoidosis Symptoms

2012 ◽  
Vol 113 (3) ◽  
pp. 240-245
Author(s):  
O. Vougiouka ◽  
M. Moustaki ◽  
P. Nicolaidou ◽  
Andrew Fretzayas
Keyword(s):  
Fever Of Unknown Origin ◽  
Clinical Manifestations ◽  
Unknown Origin ◽  
Clinical Spectrum ◽  
Juvenile Sarcoidosis

We report a case of juvenile sarcoidosis, emphasizing the variety of clinical manifestations. The child had uveitis, which is among the most common manifestations of the disease. However, fever of unknown origin, glomerulonephritis and lymphadenopathy were also noticed, underscoring the diversity of the clinical spectrum of the disease.

Sign in / Sign up

Export Citation Format

Share Document