Presented by Dr. Ahmed Khairy.
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Staff of the Unit:
Prof.Dr. Mahasen Abdel-Rahman
Dr.Abdel-Maged Kasem
Dr.Hisham El-Makhazangy
Dr.Naglaa Zayed
Dr.Sherif Hamdy
Dr.Mohamed Seif
Dr. Rabab Salama
Dr Khaled El-Sherif
Resident.Hadel gamal
Resident.Ahmed Khairy
Brucellosis
Personal History
Male patient .
22 yrs old.
Single
Works as Wood painter.Now he is in Military service.
Born and living at Tawabk Giza.
Smokes 5 cigarettes /day for 8 years.
History of contact with canal water but no anti-schistosomal ttt .
Complaint
Fever
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Present history
The condition started 1 month before admission by: Fever 39c continuous for 4 days not responding to antipyretics,, associated with headache& malaise, not associated with profuse sweating, rigors or chills.
Then the patient was admitted at fever hospital, where he received treatment not specified by the patient& fever subsided after 1 weak.But he started to develop Diffuse colicky abdominal pain all over the abdomen, not radiating nor referred, with no special precipitating or relieving factor.associated with vomiting after meals
Then the patient experienced yellowish discolouration of the sclera, palpitation, dizziness& blurring of vision, followed by disturbed consciousness, Fainting& developed left eye haematoma but he did not developed sensory, sensory, motor, or cranial nerve affection. CT brain& Lumbar culture were done. He was told to have anaemia.
The patient was improved after receiving 2 units of blood& then discharged.
Then he was referred to our department with recurrence of abdominal pain, vomiting,dizziness.
No loss of appetite , loss of weight or skin eruption.
No body masses or bony pains.
No change in bowel habits, colour of urine or stool.
No Cough, Expectoration, dysuria or frequency of micturition.
No history of recurrent infections.
No history of orthopnea, PND.
No history of ascites, LL edema.
No close contact with animals.
No history of travelling abroad.
No history of drug intake.
Past history:
- No DM - No hypertension
Operation for adenoid 3 years ago.
No previous blood transfusion
Family history:
No similar conditions
Negative consanguinity
General examination:
The patient is drowsy, lying comfortably flat in bed.
Pulse: 88/min, regular, average volume, no special character, equal on both sides.
Bp : 120 /70
Temp :37.1
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Head & Neck
Pallor
Tinge of jaundice
Lt eye haematoma ,subcojunctival haemorrhage
No cyanosis
Cervical lymph nodes :2 Rt submandibular, 2 bilateral upper cervical 0.5x 1cm , firm, mobile, not tender, not adherent to overlying skin.
Neck veins : not congested
Thyroid gland : not enlarged
Trachea : central
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UL &LL:
Neurological examination: No sensory, motor or cranial nerve affection. Normal gait.
Abdominal examination
Summary:
High fever.
Abdominal pain,vomiting.
Anaemia, tinge of jaundice.
Subcojunctival hge.
Disturbed conscious level.
Differential Diagnosis
Investigations
Stool analysis: free
Stool culture: free
CBC :
Liver biochemical profile
Kidney function tests:
Chest X-Ray : Free
Abdominal Ultrasound:
- Liver : Average size, Homogenous echopattern, Portal tract thickening, smooth surface and normal hepatic veins. No focal lesions or IHBR dilatation .Hepatic veins are normal. P.V. 13.4mm.
-Gall bladder: Average size and wall thickness, no stones or mud inside. CBD is not dilated.
-Spleen : enlarged (longest axis is 15.6 cm) homogenous echopattern.
-Kidneys :Both are of average size& parenchymal echogenicity. .No calculi, cysts or backpressure changes.
Lumbar puncture &CT Brain: free
HIV Negative
Tuberculin test Negative
ANA:Negative
Blood culture : Coagulase negative staph.
Widal test:
Typhoid (O) 1/640
Typhoid (H) Negative
Brucella agglutination test:
B.Abortus 1/5120
B.Melitensis Negative
Echocardiography: Free
X-RAY Sacroiliac joints: Free
THANK YOU
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