A 5-month history of fever and dry cough in a 67-year-old man
- PDF / 720,133 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 60 Downloads / 168 Views
IM - CASE RECORD
A 5‑month history of fever and dry cough in a 67‑year‑old man Federica Depetri1 · Paolo Tarsia2 · Maria Francesca Donato3,4 · Federica Invernizzi3,4 · Massimo Cugno1 Received: 23 March 2019 / Accepted: 12 June 2019 © Società Italiana di Medicina Interna (SIMI) 2019
Case presentation Dr. Depetri, Dr. Invernizzi A 67-year-old man presented to the emergency department (ED) for a 5-month history of fever and dry cough, whose nature remained undefined notwithstanding two hospitalizations elsewhere. The patient had received liver transplant 20 years earlier for hepatitis B virus-related cirrhosis. He suffered from chronic kidney disease, type 2 diabetes, arterial hypertension, and hypothyroidism. Moreover, the patient had mitral and aortic valve disease from a previous endocarditis, he was a pacemaker carrier, and he was on oral anticoagulant therapy with warfarin for permanent atrial fibrillation. One year earlier, the patient was diagnosed with Kaposi’s sarcoma, involving the skin of the left leg and gingival mucosa, requiring topical therapy with vincristine and a change of the immunosuppressive treatment (everolimus instead of mycophenolate mofetil plus tacrolimus). Kaposi’s sarcoma was associated with high circulating levels of human herpesvirus 8 DNA which disappeared after the therapy mentioned above. In the last 5 months, the patient complained episodes of fever which was irregular, intermittent, presenting once a * Massimo Cugno [email protected] 1
Medicina Interna, Dipartimento Di Fisiopatologia Medico‑Chirurgica E Dei Trapianti, Università Degli Studi Di Milano, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122 Milano, Italy
2
Dipartimento Di Pneumologia, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca’ Granda, Milano, Italy
3
Unità Di Epatologia Dei Trapianti, Divisione Di Gastroenterologia Ed Epatologia, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca’ Granda, Milano, Italy
4
Centro Per Lo Studio Delle Malattie del Fegato “A. M. E A. Migliavacca”, Università Degli Studi Di Milano, Milano, Italy
week with peaks at 38.3–39.0 °C, associated with chills, lasting a few hours and responding to acetaminophen. After fever appearance, the patient was hospitalized twice in another city and was investigated with repeated cultural tests (blood and urine), chest X-ray, and CT scan. Due to the negativity of all the tests, empirical therapy with wide spectrum antibiotics was administered. During the second hospitalization, even though blood cultures were negative and no signs of endocarditis were evident at transthoracic echocardiography, a recurrence of infective endocarditis was suspected and the patient was treated with vancomycin and gentamicin intravenously. Fever temporarily disappeared, but due to acute renal failure, antibiotics had to be discontinued and intravenous hydration administered. The patient was discharged, but soon later, fever reappeared, so he presented to the ED of our hospital in Milan. At the ED, blood tests showed normocyti
Data Loading...
