[Adult-hlh-mas] Securemail Clements

Brittany Ahmed BRITTANY.AHMED at phhs.org
Thu Aug 23 14:01:24 CDT 2018


I have a patient at Clements on whom we wanted to get the task force's opinion.

MRN 91897375

Ferrer, Jose

Jose Ferrer is a 44 year old Filipino male physician with hyperlipidemia, hypertension, and recent admit (8/10/2018 - 8/17/2018) for fever of unknown origin suspected to be due to an infectious cause. The fevers had been ongoing for 5 weeks prior to that admission, along with chills, sweats, generalized weakness, arthralgias, and myalgias. He has had extensive travel to India, Kenya, Tanzania, Senegal, and the Philippines. He was asymptomatic while abroad, but the symptoms started on arrival to the US.

Briefly, during recent admit, he had extensive evaluation was found to + Brucella Ab IgM along with left knee arthritis (aspirated, no growth), right shoulder arthritis (aspirated, no growth), and left calf abscess that underwent I&D by general surgery. He was discharged on ceftriaxone + rifampin + doxycycline.

He was readmitted with symptoms of fever (104.6 max), loose stools, and nausea that had not improved since discharge. Antibiotics were held as it was thought that this could be adult onset Still's Disease.

Labs on admission:
ESR 100
CRP 142.6
Ferritin 45621
Fibrinogen 509
LDH 720

Heme/Onc was consulted and they will perform BM biopsy. Soluble IL-2 receptor is pending in lab.

So far, we have started him on Solu-Medrol 1000 mg on 8/22.

Thank you for review of this case!

Brittany Ahmed
Rheumatology Fellow PGY V

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