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Case (74)

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Hazar:
Patient by name jayanth came to the hospital with chief complaints of fever since one week, associated with chills and rigors.the symptoms resemble malaria but smear examination shows negative.when we gave quinine (oral)the patient develops severe vomiting.widal negative,dengue negative.we r giving iv ringer lactate and quinine.
1.what is ur diagnosis?
2.what invistigations should do for that patient?
3.what treatment wil u give?
4.what is pyrexia of unknown origin(puo)?
5.what are organisms causing puo?
 

Dr.Noora:
I would like to know few answers from U Hazar .
1. with iv quinine the pt has not improved with treatment as its obvious from the question so how ur iv quinine is justified in this case ?
2. pyrexia of unknown origin is too short for a week duration as in this case and the scenario hints towards diagnosis of puo which i did not agree with?
3. i see there is a need for little more points which will shorten the DD ?

Hazar:
Yes Dr.Noora, we suspect that it may malaria, because we r endemic for that. Before the completeness of investigations we started antimalarials..so, we continued for full course..  And malarial become negative..then we sent for brucella,typhoid,leptospira,and dengue fever. all are negative..my professor said that its nothing but just only drug induced fever..they stopped treatment for 2 days. He is okay..today
thank u Dr.Noora

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