The patient is a 61 year old male suffering from benign mucous membrane pemphigoid for the last 18 years. Within the first year of the rare disorder he lost his eyesight. All conventional drugs were being given to him including steroids, because of which he has now osteoporosis, cushing's syndrome, lack of muscle mass, etc. on advice of the dermatologist, he stopped taking the steroids since last 2 years. He also has cervical spondilitis and had undergone surgery for disc slip 4 years back.
The present problem is that since 25 days, he has been suffering from a high grade fever, which was absent after a week's dosage of antibiotic for a couple of days. initially it was thought to be viral fever. But antibiotics were started on the 5th day on advice of doctor since there was excruciating body pain, esp in lower extremities, with an unability to even walk. 2 days later a higher order antibiotic was prescribed by the doctor, which continued for 5 days, but there was no relief from either pain or fever initially. and added symptoms of coughing and breathlessness were shown with low blood pressure, to which the doc adviced X ray chest, which came out to be clear. the tess done earlier for dengue, typhoid or malaria came out to be all negative. and suddenly 4 2 days the fever was almost 99 degrees, but no relief from pain. on advice of a neurologist, a short term (2 days) course of steroids was taken to get a relief from muscular myalgia in lower extremities. after 2 days the appetite increased a little and pain was gone but suddenly the fever was again high grade.
So on advice of another doc, blood samples were given for lab testing for various checks including Blood culture. the noticeable blood reports were of blood ESR increased from the earlier reports and increased count of leukocytes. ecg, x-ray, and other reports were normal. the blood culture sample has not shown any growth even after five days. meanwhile the doc adviced a first gen injectable antibiotic Tazobactum combination 8 hourly for five days. even after five days, there is no relief from fever which is usually ranging between 101 to 104 degrees, and cough ,sputum or breathlessness. the sputum sample has now been given for culture to find out if any fungal infection is present, waiting for the reports.
for a doubt of flaring up again of BMMP the dermatologist advice was sought and throat was shown to an ENT specialist, which denied BMMP.
So can anyone help out with the diagnosis?