09/04/2022
*INTRESTING case*
21 year male, admitted with high grade fever, abdominal pain and headche of 5 days. Routine investigation suggested viral like illness
CBC- Normal with lymphocytosis of 60%, LFT - Normal, USG - terminal ileitis, blood culture - no growth
Started with ceftraixone and azithromycin
It is day 7 of antibiotics but fever is persistent, daily high grade with severe myalgia. Relatives are anxious now. Repeat blood investigation suggested
CBC - Again normal with lymphocytosis
Now LFT alteration started
Bili- 4 (D-3.8), SGPT-172
Brucella IgM and IgG Elisa - normal
Repeat blood culture- no growth
HIV, HBsAg, HCV - negative
ANA - negative
Today is day 14 of fever
Daily high grade
What could be DD
- lymphoma
- kochโs
- deep seated infective focus
On examination- Multiple cervical lymph nodes found
CECT CHEST AND ABDOMEN - multiple abdominal node, non necrotic
Now diagnosis is clear
Young patient
PUO
Lymphocytosis
Multiple lymph node enlargements
Probable diagnosis - Infectious mononucleosis
EBV IgM was asked which came positive
Treatment suggested - only paracetamol and supportive care ๐
Patient became afebrile by day 18 ๐
Dr Anil Italiya (MD medicine)
Dr Pratik Savaj (ID specialist)
