Day 1 :
- Rare Diseases
A 36-year-old gentleman presented to the emergency department with a 7 days history of high fever, lethargy and generally unwell. He had no significant past medical history. Physical examination showed he was tachycardias with temperature of 103-degree Fahrenheit (39 degree Celsius) and systolic BP of 100 mm Hg. He was slightly icteric with a few palpable groin lymph nodes and a 3 cm palpable liver. Blood tests showed WBC count of 6000 per cubic millimeter or 6*10’cells per liter, liver functions were slightly deranged with a bilirubin of 52 and ALT OF 7Su/I. Blood for malaria parasites, Dengue NS 1 antigen was negative, urine dipstick as negative, chest x ray as normal, ultrasound scan of abdomen revealed enlarged liver. Patient was suspected as having Enteric fever- (Typhoid). He was started treatment with Intravenous Ceftriaxone. But patient became more unwell and was transferred to HDU. A further thorough clinical examination revealed a dark scab in the abdomen as shown in the photo below. Patient had further set of blood tests to screen for other tropical infection such as Scrub typhus, Leptospirosis, and it showed positive for scrub typhus IgM antibody scrub typhus. Patient was started on Doxycycline 100 mg twice daily and he recovered in a few days.
Mohamed Abass Ahmed Abdalaziz is a dedicated healthcare professional at Luton & Dunstable University Hospital, UK.