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Hello.I live in Europe and i would like to mention a case that bothers my brother in law for about two months.
He is 38 years old ,5 ft 7" and before his illness his weight was 177 (now he is 163).
He is a smoker for 20 years and he drinks quite a lot (not an alcoholic).He also works a lot (12 hours a day,6 days a week, sometimes Sundays also )
Early March he developed arm and leg pains that were more severe when he walked or used his hands.He had also aches at his
shoulders.After a few days he developed swelling at his ankles (both of them).It was so intense that he could not wear his shoes.
Two days later came the high grade fever.He had fever two or three times a day and It was between 100.4 and 104.
The first trip to a pathologist was made.He ordrered blood and urine work and gave him some anti-inflammatory and something for the fever.
The results from the tests was (only the abnormal) WBC 3.70,HGB 11.8,MCV 103.3
SGOT 83,SGPT 98,γ-GT 105,Erythrocyte Sedimentation Rate 82,CRP positive,ferritin 213.5.
After five days with no improvement he was refered to a Rheumatologist who put him in a University hospital for further tests and treatment.
He stayed in for 5 days and was given Antibiotics (IV) and Anti-inflammatory.He was given (twice) a full blood & urine tests that were
"normal" as they said except LDH 271-240,SGOT 39-37,SGPT 82-89,ALP 109-157,Erythrocyte Sedimentation Rate 125-124,WBC 3.2-2.4.
He also had Chest,feet and arm x-rays,ECG,Upper and lower abdomen Echo ,Upper,lower and chest CT Scan,Heart Echo from the esophagus all normal.
Some results are still expected ( HLA,Bone Marrow culture).The swelling at his ankles went away and the fever was lowered to 100.4
He was released with the diagnosis "Septic Arthritis- Fever of unknown origin" and he was given a new course of antibiotics.
A few days later the high grade fever came back.We called a family friend doctor (a haematologist) who examined him and
found his neck gland swollen and "something like a pea" on it.He advised him to remove the galnd and have a biopsy.
He suspected Hodjkin lymphoma.The surgeon who opened him said that there was nothing there and refused to remove the gland but took a sample
for biopsy ( the results are expected ).
The haematologist ordered more blood test.The (abnormal only) results were
SPTP 51,γ-GT 306,HDL 27,ALP 192,CPK 440,LDH 291,Fe 6,WBC 2.31,RBC 3.43,HGB 11,HTC 32,MCH 32.2,CHCM 32,β2m 3.94,ferritin 611.15
CRP 27.80,Toxo IgG Positive(305),Epstein-Barr Positive(5,3),CMV IgG Positive,Widal Typhi-H 1/20 Positive 1/40 Positive 1/80 Positive.
He completed another course of antibiotics (wide spectrum) but ...
The high grade fever is always here.It comes in waves two or three times a day (always the same time!) with chills and shivering.
He takes suppositories for the fever and nothing else.He has lost his strength and walks with difficulty.
He is always shaky and has lost his appetite.He has been transformed to a living wreck.
Another thing that is worrying is his mental condition after so long time being without a proper diagnosis and treatment.
And now comes the question.Do all the above sound to you like "septic arthtitis"?
Is it something else that was misdiagnosed ? A strange auto immune disease or an infection of "unknown" origin?
We would appreciate any ideas and directions on what else to search for.
Im sorry for the length of my post but i tried to give yoy the full picture of the case.
Thank you in advance.

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