MKSAP: 35-year-old woman is evaluated for intermittent fever

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 35-year-old woman is evaluated for intermittent fever, sweats, fatigue, and dull midchest pain of 2 weeks’ duration. Medical history is significant for liver transplantation 6 months ago for primary biliary cirrhosis; she was seronegative for cytomegalovirus and Epstein-Barr virus, and her donor was positive for both. Results of pretransplant testing for tuberculosis were negative. She received valganciclovir prophylaxis for 3 months after transplantation. Medications are tacrolimus, prednisone, mycophenolate mofetil, and trimethoprim-sulfamethoxazole. On physical examination, temperature is 37.7 °C (99.9 °F), blood pressure is 142/88 mm Hg, pulse rate is 92/min, and respiration rate is 14/min. Oropharynx has whitish plaques on the palate and buccal mucosa. No enlarged lymph nodes are palpable. Cardiopulmonary examination is normal. Abdomen is soft and nontender without hepatosplenomegaly. Extremities are without edema. No skin lesions are noted. Laboratory studies are significant for a leukocyte count of 5200/µL (5.2 × 109/L) and hematocrit of 33%. Liver and kidney function are normal. Bacterial and fungal blood cultures show no growth. Chest radiograph shows clear lung fields but left hilar enlargement. Chest CT confirms an enlarged, 3-cm left hilar lymph node; the liver and spleen are unremarkable. Which of the following is th...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Allergies & Immunology Infectious Disease Source Type: blogs

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CONCLUSION: Documenting carer, service provider and healthcare practitioner perspectives on skin infections provides a more informed understanding of the context in which treatment decisions are made. The ongoing need for culturally appropriate targeted, translational health education; improved treatment guidelines and feasible, painless treatments; and potential for the use of bush medicines for skin infections were themes that emerged. PMID: 31540550 [PubMed - in process]
Source: Rural and Remote Health - Category: Rural Health Tags: Rural Remote Health Source Type: research
No abstract available
Source: Lippincott's Bone and Joint Newsletter - Category: Orthopaedics Tags: Snapshot Source Type: news
How to identify the culprit — and which drugs, injections and habits will bring you the most relief ... You are leaving and going to the website of our trusted provider. ... The provider’s...
Source: News - Category: American Health Source Type: news
Source: Journal of Asthma and Allergy - Category: Allergy & Immunology Tags: Journal of Asthma and Allergy Source Type: research
Publication date: November 2019Source: Food Research International, Volume 125Author(s): Sachin Kumar, Shariqua Khan, Ajay Kumar Verma, Premendra D. DwivediAbstractTree nut along with peanut are among the most potent food allergens, responsible for frequently inducing the IgE-mediated hypersensitivity reaction. Our aim was identification, purification of Buchanania lanzan (Bl-11 kDa) protein along with characterization and assessment of allergenic potential of clinically relevant allergen. Further study was executed in clinical samples of sensitive patients, BALB/c mice, and in-vitro. A major IgE binding 11-kDa protein f...
Source: Food Research International - Category: Food Science Source Type: research
Discussion Pulmonary embolism (PE) is potentially life-threatening but fortunately rare event especially in the pediatric population. It was first described in children in 1861. PE is likely underreported because of minimal or non-specific clinical symptoms. The incidence is estimated at 0.05-4.2% with the 4.2% based on autopsy reports. It is probably also increasing as more central venous catheters (CVC) are used, and more children are surviving previously poor prognostic diseases. There is a bimodal distribution with cases
Source: - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
Source: Journal of Pain Research - Category: Anesthesiology Tags: Journal of Pain Research Source Type: research
Source: Journal of Pain Research - Category: Anesthesiology Tags: Journal of Pain Research Source Type: research
ConclusionThe current study highlights the potential of LAMP test for the specific diagnosis of tubercular lymphadenitis in FNAC samples from HIV-infected patients, especially when cytology is either non-conclusive or non-available. Though MPCR had a higher sensitivity than LAMP assay, the added advantages of low cost, minimal technical expertise and simplicity of procedure make LAMP assay a suitable diagnostic test in resource-limited settings.
Source: Molecular and Cellular Probes - Category: Molecular Biology Source Type: research
ConclusionACUTE ABDOMEN sonographic approach in acute abdomen can play an important role in ruling out critical diagnosis, and can guide emergency physician or any critical care physician in patient management.
Source: Critical Ultrasound Journal - Category: Radiology Source Type: research
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