scholarly journals DELAYED DIAGNOSIS OF EXTRAPULMONARY TUBERCULOSIS PRESENTING AS FEVER OF UNKNOWN ORIGIN IN BIHAR

2020 ◽  
pp. 12-15
Author(s):  
Sant Kumar ◽  
Prabhat Kumar Sinha ◽  
Debarshi Jana
Keyword(s):  
Fever Of Unknown Origin ◽  
Comprehensive Evaluation ◽  
Imaging Finding ◽  
Extrapulmonary Tuberculosis ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Unknown Origin ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Atypical Presentations

Background: Tuberculosis (TB), especially extrapulmonary tuberculosis (EPTB), is an important cause of fever of unknown origin (FUO) in Bihar. Little information is known about patients with EPTB with clinical features presenting as FUO and about the factor of delaying the diagnosis. Material and Methods: We retrospectively analyzed EPTB patients at DMCH, Laheriasarai, Bihar, who were referred with FUO fromMithilanchal area around like; Darbhanga, Madhubani, Samsatipur and other places. The subjects were assigned to groups of early diagnosis and delayed diagnosis within3 days of an initial comprehensive evaluation from the referral. Clinical and laboratory variables were compared between the groups. Results: A total of 95 patients with febrile EPTB were included. Localizing symptoms and/or signs suggestive of anatomy were identified in 62.1% of the patients. Concurrent lung involvement by TB was presented by 49.5% (47/95) of the patients, and only 23.4% of them showed typical findings of pulmonary TB on simple chest X-ray. Most of the patients showed abnormal lesions on cross-sectional CT (98.9%) and MRI (100%). The clinical variables and blood test results of patients were not significantly different between the two groups. The less typical imaging finding of EPTB on CT (38.5% vs. 79.0%) and MRI (37.5% vs. 79.0%) in the delayed diagnosis group was a risk factor for delayed diagnosis. Conclusion: Febrile EPTB referred as FUO showed nonspecific clinical manifestations. The active application of cross-sectional imaging tests according to clinical clues or randomly in the absence of local manifestations, combined with invasive diagnostic approaches even for atypical presentations may lead to an earlier diagnosis of febrile EPTB.

scholarly journals Delayed diagnosis of extrapulmonary tuberculosis presenting as fever of unknown origin in an intermediate-burden country

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Jeong-Han Kim ◽  
Eu Suk Kim ◽  
Kang-Il Jun ◽  
Hyun gul Jung ◽  
Ji Hwan Bang ◽  
...  
Keyword(s):  
Fever Of Unknown Origin ◽  
Extrapulmonary Tuberculosis ◽  
Delayed Diagnosis ◽  
Unknown Origin

Periaortic air in native and post-operative aorta on computed tomography

2021 ◽  
Author(s):  
Mansi Verma ◽  
Amit Ajit Deshpande ◽  
Niraj Nirmal Pandey ◽  
Sanjeev Kumar
Keyword(s):  
Computed Tomography ◽  
Clinical Laboratory ◽  
Radical Surgery ◽  
Imaging Finding ◽  
Radiological Findings ◽  
Catastrophic Event ◽  
Cross Sectional ◽  
Pictorial Review ◽  
Cross Sectional Imaging ◽  
Indispensable Tool

Periaortic air can be seen in various conditions which can be a benign imaging finding or harbinger of a catastrophic event. The causes vary in native aorta and post-operative aorta. A radiologist has an important part in the management process of these patients, as the treatment varies from conservative to radical surgery based on the aetiology. The presence of periaortic air seen in the light of various clinical, laboratory and radiological findings can guide the radiologist towards a particular aetiology. Cross-sectional imaging, mainly computed tomography, is an indispensable tool in recognising ectopic periaortic air and to identify the associated findings and eventually make an accurate diagnosis. We present a pictorial review of various causes of the periaortic air in native and postoperative aorta, the salient features and management of the described conditions.

Abstract 212: Acute Myocardial Infarction in the Acute Phase in Kawasaki Disease in Mexican Children.

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
William Sarmiento-Robles ◽  
Luis M Garrido-Garcia
Keyword(s):  
Myocardial Infarction ◽  
Kawasaki Disease ◽  
Acute Phase ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Unknown Origin ◽  
Z Score ◽  
Laboratory Parameters ◽  
Small Series ◽  
Coronary Aneurysms

Background: Kawasaki disease (KD) is an acute febrile vasculitis of unknown origin. Despite treatment with intravenous immunoglobulin during the acute phase of the disease, up to 5% of those affected will develop coronary aneurysms predisposing them to thrombotic complications that could result in myocardial infarction (AMI). In Mexico there are few reports of ischemic complications secondary to KD. Objective: To describe the clinical features, the laboratory parameters, treatment used and the outcome of children who presented with myocardial infarction during the acute phase of KD in a third level facility in Mexico City Methods: From our Institutional Database of KD we search for children who presented AMI in the acute phase of the disease from August 1995 to August 2014. We analyzed gender, age, clinical manifestations, time from the onset of the symptoms to diagnosis, laboratory parameters, treatment used, and outcome in the acute phase of the disease. Results: Eight infants were diagnosed with AMI during the study period. The median age at diagnosis was 8 months (range 2 to 53 months). Seven patients were male (87.5%). The median from the onset of the clinical manifestations to diagnosis of KD was 22 days (range 4 to 26 days). All patients developed giant coronary aneurysms (median Z-score 18.98, with a range of Z-score from 11.58 - 27.70). An abnormal EKG and abnormal perfusion tests demonstrated the myocardial infarction in all cases. Two patients died in the acute phase of cardiogenic shock, one more patient died of dilated cardiomyopathy 12 months after coronary bypass surgery with an overall mortality of 62.5% of this group. Conclusions: AMI is a fatal complication of KD. In our small series it was associated with a delayed diagnosis of the disease and therefore the development of giant coronary aneurysms. Treatment of AMI in children after KD is a medical challenge with a poor prognosis in children.

scholarly journals Delayed Diagnosis of Biopsy-Negative Giant Cell Arteritis Presenting as Fever of Unknown Origin

2009 ◽  
Vol 24 (4) ◽  
pp. 532-536 ◽  
Author(s):  
Valentin S. Schäfer ◽  
Kenneth J. Warrington ◽  
Eric E. Williamson ◽  
Tanaz A. Kermani
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Fever Of Unknown Origin ◽  
Delayed Diagnosis ◽  
Unknown Origin

scholarly journals A study of etiology of fever of unknown origin in children aged 2 months to 18 years

2021 ◽  
Vol 8 (11) ◽  
pp. 1842
Author(s):  
Naveen Gandla ◽  
Sheela A. Bharani ◽  
Tushar P. Shah
Keyword(s):  
Enteric Fever ◽  
Fever Of Unknown Origin ◽  
Lymphoblastic Leukemia ◽  
Connective Tissue Diseases ◽  
Unknown Origin ◽  
Age Group ◽  
Antimicrobial Drugs ◽  
Cross Sectional ◽  
Female Ratio ◽  
Geographical Regions

Background: In an era of advance science of modern technologies, many diseases are diagnosed and excluded rapidly and now Fever of Unknown Origin (FUO) has been redefined for any fever of 380C lasting for more than 7 days without any clear cause. The aetiology varies according to different geographical regions, socioeconomical status, age, prevalence of resistance to antimicrobial drugs and genetic susceptibility.Methods: It was a descriptive cross sectional, hospital-based study, carried out on 150 children from August 2018 to May 2020. All cases in the age group of 2 months to 18 years with fever of >38.0°C, lasting for more than 7 days without a clear source were included.Results: The mean age of presentation was 5.8 years±Standard Deviation of 3.7 years with male to female ratio was 1.4:1. Nearly half of the cases, presented with the duration of fever between 8-14 days. Enteric fever in 52%, tuberculosis in 13.3% and acute lymphoblastic leukemia (ALL) in 8.5% were three common etiologies found in this study. Amongst all cases of FUO, infective causes were seen in 113 (75.3%) followed by malignancies in 15(10%) cases. In 10 (6.7%) cases, cause could not be established.Conclusions: Enteric fever and tuberculosis were the leading etiologies from infective subgroup of FUO. ALL was the commonest cause from malignancies sub group. FUO presenting with low haemoglobin, platelet is a pointer towards malignancy. Occurrence of FUO with infectious diseases and malignancies was found in younger age group as compared to connective tissue diseases. 

scholarly journals Aetiology of Fever of Unknown Origin: One-Year Experience in a Tertiary Care Hospital of Bangladesh

2016 ◽  
Vol 6 (1) ◽  
pp. 7-11
Author(s):  
Muhammad Abdur Rahimi ◽  
AKM Shaheen Ahmed ◽  
Md Delwar Hossain ◽  
Md Raziur Rahman ◽  
Swapan Kumar Ghosh ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lupus Erythematosus ◽  
Fever Of Unknown Origin ◽  
Tertiary Care ◽  
Unknown Origin ◽  
Care Hospital ◽  
Cross Sectional ◽  
Extra Pulmonary Tuberculosis ◽  
Common Causes ◽  
Extra Pulmonary

Background: Fever of unknown origin (FUO) is not an uncommon problem in general medical practice. Sometimes extensive investigations fail to reach an aetiological diagnosis; on the other hand, in few cases, fever resolves spontaneously. This study was aimed to evaluate the aetiology of FUO in a tertiary care setting.Methods: This cross-sectional study was done in the Department of Internal Medicine of BIRDEM General Hospital, Dhaka, Bangladesh from July 2012 to June 2013.Results: Among the 33 patients studied (1.23% of total admissions), 22 (66.7%) were male. Mean age of the study population was 40.2±7.9 years. Most patients (84.8%) were diabetic. Infection (20, 60.6%) was the commonest cause, followed by malignancy (9, 27.3%). Among the infective causes (20), extra-pulmonary tuberculosis (5, 25%) was the commonest, followed by liver abscess (4, 20%). Other less common causes were Kala-azar (1), malaria (2), histoplasmosis (2), melioidosis (1), cholecystitis (1), renal abscess (1), rickettsial fever (1), apical dental abscess (1) and infective endocarditis (1). Non-Hodgkin’s lymphoma (6), renal cell carcinoma (2) and hepatocellular carcinoma (1) constituted the malignant causes of FUO in this series. Systemic lupus erythematosus was the aetiology of FUO in 1 case. One case remained undiagnosed and 2 patients left hospital before a definite diagnosis could be made.Conclusion: Extra-pulmonary tuberculosis and non-Hodgkin’s lymphoma were the two most common causes of FUO in this study. Repeated history taking, clinical examinations and careful stepwise investigations can diagnose the aetiolgy in most cases of FUO.Birdem Med J 2016; 6(1): 7-11

scholarly journals Internal Herniation through Foramen of Winslow: A Diagnosis Not to be Missed

2016 ◽  
Vol 9 ◽  
pp. CGast.S38453 ◽  
Author(s):  
Edmund Leung ◽  
Simon Bramhall ◽  
Prajeesh Kumar ◽  
Moustafa Mourad ◽  
Amdad Ahmed
Keyword(s):  
Epigastric Pain ◽  
Primary Anastomosis ◽  
Delayed Diagnosis ◽  
Postoperative Recovery ◽  
Emergency Laparotomy ◽  
Cross Sectional ◽  
Foramen Of Winslow ◽  
Lesser Sac ◽  
Cross Sectional Imaging ◽  
Severe Epigastric Pain

Introduction Hernias through the foramen of Winslow are extremely rare, accounting for 0.1% of all abdominal hernias. Delayed diagnosis is often observed, resulting in bowel strangulation and high mortality. Method We present a case of a patient with strangulated ileum herniated through the foramen of Winslow. Recent literature review was undertaken on “PubMed” as a search platform using the keywords “foramen of Winslow” and “hernia”. Case Summary A 66-year-old man presented acutely with severe epigastric pain and vomiting. An emergency computed tomography scan revealed a loop of ileum in the lesser sac. At emergency laparotomy, a herniated loop of ileum that had become strangulated at its entry to the lesser sac via the foramen of Winslow was confirmed. The loop of ileum was reduced but was nonviable, which had to be resected with a primary anastomosis. The patient's postoperative recovery was uneventful. Conclusion Herniation through the foramen of Winslow is a difficult diagnosis and must not be missed. Early cross-sectional imaging and surgical intervention are advised in order to reduce morbidity.

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 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 Tentorial Dural Arteriovenous Fistulas as a Cause of Thalamic Edema: 2 Cases of an Important Differential Diagnosis to Consider

2020 ◽  
Vol 11 (1) ◽  
pp. 33-39
Author(s):  
Mougnyan Cox ◽  
Pavel Rodriguez ◽  
Suyash Mohan ◽  
Neda I. Sedora-Roman ◽  
Bryan Pukenas ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Delayed Diagnosis ◽  
Imaging Findings ◽  
Imaging Diagnosis ◽  
Cross Sectional ◽  
Arteriovenous Fistulas ◽  
Important Differential Diagnosis ◽  
Dural Arteriovenous Fistulas ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

The differential diagnosis for bilateral thalamic edema is extensive and includes vascular, neoplastic, metabolic, and infectious causes. Of the vascular causes of thalamic edema, arterial and venous infarctions are well-documented, but dural arteriovenous fistulas (dAVFs) are a relatively uncommon and widely underrecognized cause of thalamic edema. Dural AVFs are notoriously difficult to diagnose clinically, especially in the absence of hemorrhage, and cross-sectional imaging findings can be subtle. This can result in a delayed diagnosis, and occasionally, an invasive biopsy for further clarification of a purely vascular disease. In this review, we detail our experience with the imaging diagnosis of dAVF as a cause of thalamic edema and present a short differential of other vascular causes.

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