He has clear lungs, no arthritis (just arthralgias) and the following findings on hands and feet:
Thursday, October 27, 2005
Picture Friday
We were asked to see this patient with FUO. This is a 65 y/o man with CHF (EF~25-30%) with 6 weeks of daily fevers, now with arthralgias. He has been admitted twice with multiple negative Cxs and no diagnosis yet.
He has clear lungs, no arthritis (just arthralgias) and the following findings on hands and feet:
He has clear lungs, no arthritis (just arthralgias) and the following findings on hands and feet:
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5 comments - CLICK HERE to read & add your own!:
I had the same thoughts as Doug. His surface echo showed no vegetation but with Janeway lesions, splinter hemorrhages and fever beyond the duration of viral syndromes I am still thinking of persistent endovascular infection. He came in this past week so Cxs are cooking, he will have a TEE soon and in the mean time he is on Rocephin (for HACEK and Cx- endocarditis) and doxy (for Coxiella/Q fever endocarditis).
I thought the lesions were quite dramatic though. I will post updates as they develop.
Good photos. Have you thought about uploading them to Wikipedia when you have the final diagnosis?
What about ITP (thrombocytopenia) with associated petechiae?
MS II
Jon
UT-Houston Medical School
I forgot to list his CBC... his WBC is up but his platelets are normal.
Rickettsial infection: what about R. prowazekii? More common in elderly, and consistent with petechiae, but not common in US. Has he ever had typhus? There is Brill-Zinsser Disease (has he ever traveled outside th country?)
Also about the endocarditis, maybe C. psittaci (hard/impossible to culture), does he have any birds?
Jon
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