Monday, October 31, 2005

Update on Picture Friday case

This is the 65 y/o man with FUO and palmar and plantar lesions.
Since the post his temperature curve has come down nicely on ceftriaxone and doxy. He still has the skin lesions and blood Cxs (after 7 days incubation) are still negative. He is having a TEE today and RMSF and Coxiella serologies are pendng. His RF was negative but he had a +ANA with +Anti-RNP (Anti-DS-DNA, Anti SSA and SSB and other SLE markers are negative) and his CRP has come down from 30s to 20. Any other ideas?

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DKeena said...

I'm hoping the TEE or serologies will give you an answer. If he's getting better on ceftriaxone I guess disseminated gonorrhea would be another possibility, but less likely based on the appearance of the skin lesions.
A skin Bx for culture and histology might turn out to be helpful if the TEE is unrevealing (or renal Bx if there is renal involvement.)