Fever, Hemiparesis and Hyponatraemia in a 63-year-old. HIV, another Great Masquerader?

The authors describe the unusual case of a 63-year-old patient who was referred with fever and lethargy, and was found to be hyponatraemic. The patient subsequently developed hemiparesis, and neuroradiology showed several space-occupying brain lesions. The cause was later identified as cerebral toxoplasmosis in undiagnosed Acquired Immunodeficiency Syndrome (AIDS).

A Young Woman with Fever and Cervical Lymphadenopathy

Kikuchi-Fujimoto's disease is a self-limiting and rare disorder of unknown aetiology. The typical presentation includes fever, cervical lymphadenopathy and night sweats. Consequently, it is part of the differential diagnosis of infectious, lymphoproliferative and connective tissue diseases. Histology demonstrates necrotizing histiocytic lymphadenitis. Treatment is symptomatic with non-steroidal antiinflammatory agents, although there are reports of corticosteroid use in complicated cases. We present the case of a 23-year-old woman admitted to hospital for fever and cervical lymphadenopathies, and diagnosed with Kikuchi-Fujimoto's disease.

Hepcidin and Ferritin Levels in Fever of Unknown Origin: Is There a New Biomarker?

Background and objectives: Significantly elevated serum ferritin levels are associated with both iron overload and some inflammatory conditions. Hepcidin is a protein that interferes with iron absorption in inflammatory states and acts as an acute-phase reactant. Materials and methods: Here we report the case a 33-year-old patient who presented with high fever, skin lesions and arthralgia lasting for 2 weeks. His ferritin level was 13,800 µg/l and his hepcidin level was 61 ng/dl. Results: The final diagnosis was adult onset Still's disease. The condition evolved satisfactorily with steroid treatment, but after several weeks the patient presented with an unexpected recurrence. Conclusions: Hepcidin is a good inflammatory marker that could be useful in the differential diagnosis of hyperferritinaemia.

Acute Q Fever Presenting with Multi-Organ Failure: Re-Evaluation of the Initial Diagnosis

We present the case of a 48-year-old man admitted to the critical care unit with atrial fibrillation, and acute heart and kidney failure accompanied by coagulopathy and an abnormal liver test. Initially diagnosed as a non-ST elevation myocardial infarction, re-evaluation of the case led to the consideration of severe sepsis. Q fever and leptospirosis were the most probable causes and empiric treatment was initiated. A complete recovery was achieved following treatment.