Case 5

 

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history_case2

Case Description


  • Medical Setting:Hospital; A 29 year-old woman with acute
    myelocytic leukemia is in hospital seven days after
    induction chemotherapy. An indwelling central catheter
    has been in place for one-week. There is significant
    mucositis

  •  Chief Complaint/History:

    •  Fever (40 degrees) with
      cough
    •  Abdominal pain
    •  Loose stools
  • Physical Exam:

    •  Patient appears quite
      ill, with significant alopecia
    •  Temperature: 40
    •  BP: 90/40 mm Hg
    •  Pulse: 120
    •  Pharynx-significant,
      painful mucosal ulcerations
    •  Lungs-clear
    •  Chest-clear
    •  Catheter site-no
      fluctuance (fluid/air under the skin)
    •  Abdomen-soft, non-tender
  • Laboratory values:

    •  Chest x-ray-normal
    •  Urine-esterases -
    •  Blood and urine culture
      is sent
    •  white blood cell count:
      200/ml
   leukopenia   
The differential diagnosis is and fever-the source could be from the lungs, gastrointestinal tract,genitourinary tract, skin, catheter, etc.