Infectious Disease
Case 10: A Patient with Respiratory Problems and Fever
CASE
A 60‐year‐old environmental officer presented to his district general hospital with acute lower respiratory tract symptoms and fever. He admitted to non‐specific symptoms such as weight loss, reduced appetite and lethargy 2 months prior to his acute illness. There was no history of foreign travel. He had raised inflammatory markers and a right pleural effusion on his chest radiograph. He had no cardiac murmurs on examination. His pleural effusion was tapped and found to be sterile. However he was commenced on antibiotics.
Routine bloods revealed abnormal liver function tests, this initiated a liver ultrasound. He had multiple cystic/solid lesions in his liver which were thought to be abscesses. These were drained and, again, the sample was sterile. Serology for amoeba/hydatid was negative. By this time multiple blood cultures had been sent and were all negative. In total he had 4 weeks of appropriate antibiotics and his symptoms had not resolved nor had his liver lesions regressed. He continued to have spike fevers.
QUESTION 1
Your score this session: 0 of 0
What further investigation would help?