ro13-9904 and Mucocutaneous-Lymph-Node-Syndrome

Fever of unknown origin (FUO) is a rare but important disease. The definition of FUO has not changed in the last 50 years. Classical FUO is defined by an illness of at least 3 weeks duration with fever greater than 38 masculine C, and no established diagnosis after 1 week of hospital investigation. The causes of FUO can be divided in four categories: infectious diseases, noninfectious inflammatory diseases, neoplasms, and others (miscellaneous). Recent studies have surprisingly shown that despite improved diagnostic procedures the percentage of patients with FUO, in which no diagnosis after intensive investigations in specialized centres can be found, has increased. However, finding the correct diagnosis in FUO is essential for these patients for psychological and vital reasons. Therefore and because of economic reasons patients with FUO should be investigated in specialized centres with a department for rheumatology and infectious diseases.

Topics: Aged; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Diagnosis, Differential; Fever of Unknown Origin; Glucocorticoids; Humans; Male; Medical History Taking; Middle Aged; Mucocutaneous Lymph Node Syndrome; Mycoses; Parasitic Diseases; Q Fever; Sprue, Tropical; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Virus Diseases; Whipple Disease

Topics: Abdominal Pain; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antibodies, Monoclonal; Cardiomyopathy, Dilated; Ceftriaxone; Child; Clindamycin; Conjunctivitis; Diagnosis, Differential; Fever; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Infliximab; Jaundice; Male; Methylprednisolone; Mucocutaneous Lymph Node Syndrome; Nafcillin; Shock, Septic; Sodium Chloride; Treatment Outcome

Kawasaki disease (KD) is a recognised precipitant of haemophagocytic lymphohistiocytosis (HLH). Although KD has been previously described in the developing world, there are no reported cases of KD preceding HLH. We report a case of a child with a persistent rash and unremitting fever consistent with the diagnosis of KD, who was found to have HLH, after intravenous gamma globulin failed to produce a clinical response. The diagnosis was made using the revised diagnostic criteria for HLH from the Histiocyte Society (1994). She fulfilled six of the eight clinical and laboratory criteria needed to make the diagnosis.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Ceftriaxone; Child; Developing Countries; Dexamethasone; gamma-Globulins; Humans; Immunologic Factors; Lymphohistiocytosis, Hemophagocytic; Mucocutaneous Lymph Node Syndrome

Kawasaki disease (KD) is an acute, febrile, and multisystem vasculitis of early childhood with a striking predilection for the coronary arteries. The most significant complication is coronary artery abnormalities, including coronary aneurysms. The etiology of KD remains unknown. Many infectious agents including viruses have been postulated as possible causes of KD. But standard microbiologic techniques, molecular methods and serologic investigations have failed to identify an etiologic agent. We described a patient with atypical KD during cytomegalovirus infection.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Viral; Aspirin; Ceftriaxone; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Female; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Infant; Mucocutaneous Lymph Node Syndrome; Treatment Outcome; Ultrasonography