Discussions By Condition: I cannot get a diagnosis.

Confusing PUO

Posted In: I cannot get a diagnosis. 0 Replies
  • Posted By: docdsouza
  • December 6, 2008
  • 07:33 AM

I'm a consultant Physician from India treating a difficult fever
Brief history
fever with chills, dry cough, giddiness and fatigue
Pt has acne over the forehead(no discoid rash)
Liver and spleen are both palpable
Liver 2 cm, soft
Spleen 3cm, firm
No lymphadenopathy
Investigations as under
TLC 4000 P69L30E1 MP negative
Initially urine showed 15-20RBCs and 8-10 pus cells/HPF
subsequently WNL after antibiotics
HIV, HBSAg negative
USG showed 4.7mm renal calculus in Rt kidney with hydronephrosis, hydroureter(mild)
Widal negative
ANA negative
dsDNA negative
2DECHO normal

Rx given
Inj Ofloxacin 200mg IV bdfor 7 days (28/11 to 4/12)
Inj Gentamicin 60mg IV bd for 7 days(28/11 TO 4/12)
Inj artesunate full course given (2/12 TO 6/12)
Inj Piperacillin Tazobactam has now been started since 4/12/08 she still has fever
following is her fever chart
2/12 6am 102
3/12 7am 102
4/12 2am 100
4/12 8pm 102
5/12 3pm 102
6/12 6am 102
Any senior physicians please help

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