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| Selected Cases Seen by the 2006 participants |
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2006 Case # 01 of 11
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| The following patient was seen in the Medicine Service at the 450-bed Cayetano Heredia National Hospital. |
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| History: 20 yo male with a 3-week history of high fever, headache, insomnia, epistaxis, diffuse abdominal pain and 3-6 dark black loose stools per day. One week after the onset of illness, the patient was seen in a local hospital where oral chloramphenicol was prescribed but was stopped after 3 days when no improvement resulted. |
| Epidemiology: Single, bisexual, born and lives in Lima where he works as a laborer. No recent travel. Father with TB 10 years ago, no history of receiving prophlaxis. |
| Physical Examination: T 38.5°C, pulse 100, respirations 22, BP 110/75. Uncomfortable looking with no icterus, no rash. Small non-tender cervical, axillary, and inguinal lymph node enlargement. Chest clear, cardiovascular normal. Mild diffuse abdominal tenderness, no peritoneal signs, no hepatosplenomegaly. |
| Laboratory Examination:
Hct. 34% on admission, to 28% the next day. WBC 5300, 0% bands, 59% neutrophils, 1% eos, 4% monos, 36% lymphs, platelets 246K. INR 1.25. Total bili 0.5 mg/dl, alk phosp 92, ALT 129, AST 344, LDH 1012. Normal glucose and electrolytes. HIV negative. Chest X-ray normal. Abdominal ultrasound disclosed mild splenomegaly, otherwise normal. Blood cultures with no growth at 2 weeks. Widal test; O antigen negative (zero), H 1/80. Brucella agglutinins negative.
Colonoscopy was performed 3 days after admission, showing 2 lesions in the ileum. The lesion in Image A is located 10 cm from the ileo-cecal valve. A biopsy was taken.
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| This page was last updated: Monday, September 10, 2007 |
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