A Prolonged, Perplexing Pyrexia

• Published in: The American journal of medicine Vol. 122; no. 11; pp. 1001 - 1003
• Main Authors: Ruiz-Rivas, José L., MD, Val, Daniel, MD, García, Francisca, MD, Estirado, Eva, PhD, Alonso, María J., PhD, Laguna, Fernando, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2009; Elsevier Sequoia S.A
• Subjects: Adult; Axilla; Biopsy; Diagnosis, Differential; Fever; Fever - diagnosis; Fever - etiology; Follow-Up Studies; Humans; Immunity, Cellular; Internal Medicine; Leprosy; Leprosy, Borderline - complications; Leprosy, Borderline - diagnosis; Leprosy, Borderline - immunology; Leprosy, Lepromatous - complications; Leprosy, Lepromatous - diagnosis; Leprosy, Lepromatous - immunology; Lymph Nodes - pathology; Male; Medical diagnosis; Medical prognosis; Medical treatment; Skin - pathology; Time Factors
• DOI: 10.1016/j.amjmed.2009.07.003
• ISSN: 0002-9343

Ruiz-Rivas et al presents a case of a 28-year-old man who consulted doctors for a fever several weeks duration. One year prior to the consultation, the patient, a Brazilian man who had lived in Spain for 3 years, had received a probable diagnosis of alcohol-induced hepatopathy. Ten months later, he had developed fever and diarrhea and was treated with ciprofloxacin for gastroenteritis. Three weeks after that, he presented to the emergency department of another hospital with a persistent fever and a 10-kg weight loss. A blood culture showed Gram-positive cocci later identified as Staphylococcus epidermidis, and the patient was transferred to the hospital the next day. The diagnoses were multibacitlary leprosy (borderline lepromatous) manifesting as erythema nodosum leprosum and glucose-6-phosphate dehydrogenase deficiency. Although treatment regimens differ around the world, the outlook for leprosy patients has improved dramatically during recent decades. Corticosteroids are generally the initial treatment of choice for immunologic reactions. Although thalidomide is a more effective treatment for erythema leprosum, both the difficulty of obtaining this drug and its potential adverse effects have led the World Health Organization to advise against its use.