A Case of Pyrexia

68 year old male

Hailing from Cheruthiruthy
Presenting complaint
• Fever since 3 months
• Edema since 3 months.
History of presenting complaint
• The patient has history of low grade continuous fever, with
associated chills and rigor and bilateral pitting pedal edema since 3
months.
• The edema subsided but fever persisted.
• Now the patient presented with reccurent fever spikes, low in grade
with 3 spikes per day.
• He was initially treated in Aster medicity for 2 months. But the
symptoms did not subside.
Past history
• H/o CKD- ADPKD
• H/o Severe anemia
• H/o Abdominal aorta aneurysm
• H/o aortic thrombus
• H/o CAD, COPD, Systemic Hypertension
Family history
Family history of ADPKD for Grandmother, Mother and two brothers.
Personal history
• Non veg diet
• Decreased sleep and appetite
• Reformed smoker
• No allergy to drugs
Physical examination
• On examination,
Pallor present

PR-82/min
BP- 130/80 mmHg
RR- 24/min
SPO2- 98% in RA
System Examination
• Resp- NVBS
• CVS- S1 S2 heard, no murmurs
• CNS- heigher mental functions normal
• GIT- per abdomen soft, non tender, Liver palpable, bilateral kidneys
palpable.
Investigations
CBC Result Normal

Heamoglobin 8.9 13-17

Total count 11,730 4,000- 11,000

Neutrophils 75.7 40-65

Eosinophils 0.5 1-7

Lymphocytes 18.6 20-45

Basophils 1.1 0-2

PCV 27.5 40-52

Platelet 2.71 1.5-4.5

Investigations
Blood chemistry Value Normal
CRP 29.1 <0.6
Creatinine 2.8 0.4- 1.4
Investigations

• COVID antigen, Malarial antigen, Leptospira rapid card test, Scrub

Typhus IgM, IgG , Dengue antigen and Dengu serology were negative.
• Blood culture and sensitivity done on 04/04/22 showed Klebsiella
pneumonia sensitive to Polymixin and Colistin. Urine culture done
showed no growth. Urine TruNat and urine gram stain were negative.
• Blood culture done on 19/04/22 showed coagulase negative
staphylococcus ? contaminant, sensitive to cotrimoxazole, ciprofloxacin,
clindamycin, cloxacillin, doxycycline, gentamicin and tetracycline.
• Urine culture done on 19/04/22 showed no growth after 48 hours of
aerobic incubation.
Investigations
• Echo done on 26/02/22 showed RWMA, mild LV Systolic dysfunction,
trivial AR, trivial MR.
• USG abdomen taken on 04/04/22 showed Multiple hepatic, renal cysts,
with no evidence of secondary hemorrhage or infection, Prostatomegaly.
• CT abdomen taken on 20/04/22 showed Bilateral polycystic kidney and
liver disease. No obvious evidence to suggest hepatic abscess.
• CT taken on 07/03/22 showed Enlarged liver (17 cm) with multiple cysts,
bilateral kidneys enlarged with Multiple cystic lesions replacing most of
renal parenchyma, Juxtarenal abdominal aorta showing saccular
aneurysm.
Whole body PET scan
Investigations
Diagnosis
• Pyrexia of unknown origin
• Disseminated Klebsiella infection- Blood culture positive
• CKD- ADPKD
• Severe Anemia
• Abdominal aorta aneurysm
• CAD
• COPD
• Systemic hypertension
Management
• The patient was managed with IV antibiotics (Colistin Methate,
Metrogyl, Oflixacin) , PRBC transfusion and other supportive
measures.