Hi I am not a doctor myself, my uncle is - I am helping him find help for a patient of his who has had a fever for 4 years since having her child. She has seen over 10 medical specialists here in Australia, but still cannot find a solution. Below is a description about her case and her backgroud. I also have some other documents which I am going to scan later (blood tests etc...) and I can also send them to you if you like. If you know of any other forums or places where I can post this, please let me know. Your help is much appreciated. 🙂
Mrs QX, of 40 yrs old Chinese migrant. She had a baby four years ago on January 20th, 4 days after on the 24th of January she developed a fever and rigours. She was initially discharged home, but readmitted on the 1st of February for fevers and chills. She was known to have a hepatic lesion, which had previously been commented on in China. This was demonstrated on an ultrasound of the abdominal on the 4th of February, and further investigated by triple phase abdominal CT scan on 10th of February. A pelvic ultrasound raised the question of retained products, and a curette was performed on 12th of February. She received antibiotic treatment with cephazolin, flagyl and gentamicin and was discharged on oral cephalexin and metronidazole. The anaesthetic for the D&C was midazolam, fentanyl and propafol. No anaesthetic gases were used. She received analgesia with paracetamol during her admission.
After discharge from hospital she had continuing high fevers and on the day of admission she was spiking fevers to 39.8 deg Celsius.
Initially she was thought to have a drug reaction to the cephalexin or endometrial infection. A repat pelvic ultrasound was inconclusive and she had a further D & C on 5th of March, which showed no abnormality.
The hepatic lesion was investigated with a further CT scan, which suggested this was a hepatic haemangioma. Mrs QX had extensive investigations without any diagnosis forthcoming. She developed abnormal liver function test and liver biopsy was performed which showed an unusual picture of extensive necrosis, mainly in zone 3. Within the areas of necrosis there were histiocytes containing large lipid vacuoles. A hepatologist, advised as about Mrs QX?s management. It was thought that the liver pathology may be the result of a drug or toxin. Mrs QX also was known to be taking herbal remedies. Mr QX assured that she had only started taking the herbal medications a month after discharge from hospital ,that means after fevers for a month. The chemical contents of these herbal therapies are not known.
Unfortunately, the cause of Mrs QX?s fevers was not ascertained and it was subsequently decided to treat her with steroids to try and give her symptomatic control.
Mrs QX continued to spike fevers to 39.6 degrees Celsius throughout her hospital stay. It was decided that she would be treated with corticosteroids. On commencing prednisone 50 mg daily the fever promptly disappeared, and she was discharged on Prednisone 40mg a day. This was continued for two weeks then reduced to 20mg/ay with return of the fevers to 38 deg Celsius. The dose has been increased again.
Mrs QX has been having swinging temperatures from 38 to 40 degrees Celsius .The main problem at the moment continue to be intermittent fever, fatigue, weight loss of 4kg and increased hair loss.
Mrs QT emigrated from China to Australia in 1995. She had worked as a Bank Teller in China and had been previously well and healthy. She did not travel extensively and had no animal contact. Since arriving in Australia, she worked in factory soldering electronic components and her only contact using chemicals was when soldering, using flux. There is no relevant family history.
On examination, she was pale. Her blood pressure was 135/85. Her heart sounds were dual and her chest was clear. She had a moon-face and looked cushingoid. There was tenderness and enlargement of the left lobe of the liver and at 13 cm; the liver is firm in consistency. It was thought her spleen can be palpated. There is no lymphadenopathy and no signs of liver failure.
Not surprisingly this severe illness was very stressful for Mrs QX and her husband.
If you can provide any information that would be helpful to this case please email me at
[email protected] Thank you.
Mrs QX, of 40 yrs old Chinese migrant. She had a baby four years ago on January 20th, 4 days after on the 24th of January she developed a fever and rigours. She was initially discharged home, but readmitted on the 1st of February for fevers and chills. She was known to have a hepatic lesion, which had previously been commented on in China. This was demonstrated on an ultrasound of the abdominal on the 4th of February, and further investigated by triple phase abdominal CT scan on 10th of February. A pelvic ultrasound raised the question of retained products, and a curette was performed on 12th of February. She received antibiotic treatment with cephazolin, flagyl and gentamicin and was discharged on oral cephalexin and metronidazole. The anaesthetic for the D&C was midazolam, fentanyl and propafol. No anaesthetic gases were used. She received analgesia with paracetamol during her admission.
After discharge from hospital she had continuing high fevers and on the day of admission she was spiking fevers to 39.8 deg Celsius.
Initially she was thought to have a drug reaction to the cephalexin or endometrial infection. A repat pelvic ultrasound was inconclusive and she had a further D & C on 5th of March, which showed no abnormality.
The hepatic lesion was investigated with a further CT scan, which suggested this was a hepatic haemangioma. Mrs QX had extensive investigations without any diagnosis forthcoming. She developed abnormal liver function test and liver biopsy was performed which showed an unusual picture of extensive necrosis, mainly in zone 3. Within the areas of necrosis there were histiocytes containing large lipid vacuoles. A hepatologist, advised as about Mrs QX?s management. It was thought that the liver pathology may be the result of a drug or toxin. Mrs QX also was known to be taking herbal remedies. Mr QX assured that she had only started taking the herbal medications a month after discharge from hospital ,that means after fevers for a month. The chemical contents of these herbal therapies are not known.
Unfortunately, the cause of Mrs QX?s fevers was not ascertained and it was subsequently decided to treat her with steroids to try and give her symptomatic control.
Mrs QX continued to spike fevers to 39.6 degrees Celsius throughout her hospital stay. It was decided that she would be treated with corticosteroids. On commencing prednisone 50 mg daily the fever promptly disappeared, and she was discharged on Prednisone 40mg a day. This was continued for two weeks then reduced to 20mg/ay with return of the fevers to 38 deg Celsius. The dose has been increased again.
Mrs QX has been having swinging temperatures from 38 to 40 degrees Celsius .The main problem at the moment continue to be intermittent fever, fatigue, weight loss of 4kg and increased hair loss.
Mrs QT emigrated from China to Australia in 1995. She had worked as a Bank Teller in China and had been previously well and healthy. She did not travel extensively and had no animal contact. Since arriving in Australia, she worked in factory soldering electronic components and her only contact using chemicals was when soldering, using flux. There is no relevant family history.
On examination, she was pale. Her blood pressure was 135/85. Her heart sounds were dual and her chest was clear. She had a moon-face and looked cushingoid. There was tenderness and enlargement of the left lobe of the liver and at 13 cm; the liver is firm in consistency. It was thought her spleen can be palpated. There is no lymphadenopathy and no signs of liver failure.
Not surprisingly this severe illness was very stressful for Mrs QX and her husband.
If you can provide any information that would be helpful to this case please email me at
[email protected] Thank you.
