PLEASE HELP !!!!
One of my partners (peds EM physician) daughter has a mysterious illness,
currently in the PICU on the ventilator and I thought we may get help by
one of you or your colleauges...
15 years old African-American female with a three weeks duration of
intermittent high fever, jaundice and generalized lymphadenopathy
currently in ARDS.
It started 3 weeks ago with fever, malaise and myalgias followed by
jaundice and lymphadenopathy. There was some dental manipulation
done(braces) and she was on Amoxicilline. She also spent a few days on a
farm helping and had a small scratch on her thigh by a chickenwire. No
travel, no exposure to animals, foreign food ar ill persons. Past history
Her only positive labs were an elevated WBC (40-50,000 with left
shift),slightly elevated liver enzymes and gradually decreasing
albumine.Bili is 6.4, direct. Ammonia, PT,PTT and everything else you can
imagine are normal.
CT showed mediastinal and abdominal lymphadenopathy, slight
hepatosplenomegaly otherwise negative. Bone marrow exam normal, so was a
lymph node biopsy. Blood cultures negative, so were serology for the
following: coccydiomycosis, EBV, Hepatitis A,B,C, leptospirosis,
brucella,tularemia, ehrlichiosis,toxoplasma, lyme, q fever, RPR, relapsing
fever, ANA and antimicrosomal antibodies, CMV.
During her illness she was also on doxacycline, ancef and currently on
Her condition is worsening daily and nobody seems to know what is happening.
Any ideas or suggestions would be highly appreciated.
Steven Szabo, M.D., F.A.A.P.
Valley Childrens Hospital
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