A man in his 80s with arthritis and persistent fever

Febrile illness is a common clinical problem and frequently caused by bacterial and viral infections. When blood cultures are negative and symptoms persist despite empirical antibiotic treatment, clinicians must consider other differential diagnoses including malignancy, rheumatologic disease and pa...

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Bibliographic Details
Published inTidsskrift for den Norske Lægeforening Vol. 139; no. 13
Main Authors Blomberg, Bjørn, Müller, Karl Erik, Helgeland, Lars, Fladeby, Cathrine, Mørch, Kristine
Format Journal Article
LanguageEnglish
Published Norway 24.09.2019
Subjects
Aged, 80 and over
Amphotericin B - administration & dosage
Amphotericin B - therapeutic use
Antiprotozoal Agents - administration & dosage
Antiprotozoal Agents - therapeutic use
Arthritis - parasitology
Fever - parasitology
Humans
Leishmania infantum - growth & development
Leishmania infantum - isolation & purification
Leishmaniasis, Visceral - complications
Leishmaniasis, Visceral - diagnosis
Leishmaniasis, Visceral - drug therapy
Male
Pancytopenia - parasitology
Spain
Splenomegaly - diagnostic imaging
Splenomegaly - parasitology
Tomography, X-Ray Computed
Travel-Related Illness
Spain
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Summary:Febrile illness is a common clinical problem and frequently caused by bacterial and viral infections. When blood cultures are negative and symptoms persist despite empirical antibiotic treatment, clinicians must consider other differential diagnoses including malignancy, rheumatologic disease and parasitic infections. A Norwegian male in his eighties experienced febrile illness during a stay in Southern Spain. Upon return to Norway, he was hospitalized with fever, weight-loss, enlarged spleen, pancytopenia and hypergammaglobulinemia. After failing to respond to broad-spectrum antibiotics and antifungals, he was diagnosed with visceral leishmaniasis and Leishmania infantum was confirmed by PCR and sequencing of spleen biopsy and blood. With increasing migration and tourism, doctors in non-endemic countries should be familiar with visceral leishmaniasis.
ISSN:0807-7096