This is the 65 y/o man with FUO and palmar and plantar lesions posted on Picture Friday. There have been a few very good new comments on the original post. Dr Jon wrote:
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?
He did not have birds and no exposures to suggest typhus. No recent travels. His serologies for Q fever, RMSF, Rickettsia prowazekii and Ehrlichia came back today and were all negative. He has remained afebrile and his Janeway lesions are resolving. A skin punch biopsy was interpreted as infectious embolic vasculitis though no organisms were seen. All Cxs remain negative. A TEE showed no veggies but there were some echo changes at the PM atrial lead site concerning for a small endocardial abcess. His CRP is down from 30 to 6 but now his Creatinine has crept up from <1.5>3%.
So we are still treating him for Cx- IE. Any other ideas?
Thursday, November 03, 2005
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I think the key is that your current treatment is working. I'd continue to treat for CN-endocarditis, for a minimum of 6 weeks.
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