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Author: Pediatric Oncall

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Case Report: - A 14 years old boy presented with fever with chills for one and a half months for which he had received Doxycycline Chloramphenicol {for positive Weil Felix test}, Pyrimethamine, Sulphadoxine and Piperacillin -Tazobactum. However fever still persisted. He also had fever a month ago prior to this episode and received Ciprofloxacin, Amikacin, Azithromycin, Chloroquine, Amoxycillin-Clavulanic Acid. There is no TB or TB contact. The child has good appetite, has no loss of weight. On examination, he is febrile, has mild hepatosplenomegaly. Other systems are normal. Investigations show:
• SGOT = 28 IU, L
• SGPT = 18 IU, L
• OptiMAL Test for malaria = Negative
• Leptospira Rapid test = Negative
• Creatinine = 0.7 mg percent
• Widal = Negative
• Urine = Normal
• Chest X-Ray = Normal
• Use Abdomen = Normal
• Echocardiography = Mild prolapse of anterior mitral leaflet , No vegetations
• Blood culture = No growth
• Dengue IgM = Negative
• HIV ELISA = Negative
• RA factor, ANA, dsDNA = Negative
• CMV IgM, EBV nuclear antigen IgG = Negative
• Bone marrow examination = Normal
• Mantoux test = Negative
• S. Ferritin = 95.3 ng, ml {Normal}
• CT abdomen = Normal
• Brucella IgG, IgM = Negative
Weil Felix Test
Day 4: OX – 19 is 1:160, OX – K and OX-2 is negative
Day 12: OX – 19 is 1:160, OX – K and OX-2 is negative
Day 35: OX – 19 is 1:160, OX – K is negative and OX-2 is 1: 160

Case Report: - A 14 years old boy presented with fever with chills for one and a half months for which he had received <a class='interlink' href='/drugs/antimicrobial-tetracyclines/doxycycline/33/517'>Doxycycline</a> <a class='interlink' href='/drugs/antimicrobial-others/chloramphenicol/29/399'>Chloramphenicol</a> {for positive Weil Felix test}, Pyrimethamine, Sulphadoxine and <a class='interlink' href='/drugs/antimicrobials-penicillin/piperacillin/30/878'>Piperacillin</a> -Tazobactum. However fever still persisted. He also had fever a month ago prior to this episode and received Ciprofloxacin, Amikacin, Azithromycin, Chloroquine, Amoxycillin-Clavulanic Acid. There is no TB or TB contact. The child has good appetite, has no loss of weight. On examination, he is febrile, has mild hepatosplenomegaly. Other systems are normal. Investigations show:
<br>• SGOT = 28 IU, L
<br>• SGPT = 18 IU, L
<br>• OptiMAL Test for malaria = Negative
<br>• Leptospira Rapid test = Negative
<br>• Creatinine = 0.7 mg percent
<br>• Widal = Negative
<br>• Urine = Normal
<br>• Chest X-Ray = Normal
<br>• Use Abdomen = Normal
<br>• Echocardiography = Mild prolapse of anterior mitral leaflet , No vegetations
<br>• Blood culture = No growth
<br>• Dengue IgM = Negative
<br>• HIV ELISA = Negative
<br>• RA factor, ANA, dsDNA = Negative
<br>• CMV IgM, EBV nuclear antigen IgG = Negative
<br>• Bone marrow examination = Normal
<br>• Mantoux test = Negative
<br>• S. Ferritin = 95.3 ng, ml {Normal}
<br>• CT abdomen = Normal
<br>• Brucella IgG, IgM = Negative
<br>Weil Felix Test
<br>Day 4: OX – 19 is 1:160, OX – K and OX-2 is negative
<br>Day 12: OX – 19 is 1:160, OX – K and OX-2 is negative
<br>Day 35: OX – 19 is 1:160, OX – K is negative and OX-2 is 1: 160<br></table>

What is the diagnosis_?

Answer Discussion :

T

tin ayecash

0

Rickettsial infection , drug fever

15 years ago

N

nadinecash

0

Tick bite fever

15 years ago

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Answer 1

The child responded to Naproxen as suspected autoimmune disorder. The child is on follow up. A differential diagnosis of Familial Mediterranean fever is also considered.

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