Clinical & Medical CASE REPORTS

Biography

Afsaneh Motevalli Haghi has completed her PhD from Tehran University of Medical Sciences. She is assisstant professor of the department of Medical Parasitology and Mycology, School of Public Health. She has published more than 40 papers in reputed journals and has been serving as a member of  Iranian Scientific Association of Parasitology

Abstract

BACKGROUND: The incidence of fever and hemolysis is not rare, but these manifestation with some organism (dots) on RBCs is extremely rare and very dangerous.
CASE REPORT: A 45 years old man was admitted in hospital with fever and chills and confusion. He had a Past medical history including depression and psychological problem from 6 months ago also, social history were contact with hamster 5 years ago and contact with cats recently. Moreover, in Lab tests the following results were observed: WBC: 6500, Hb: 6.5, plt: 255000, retic ↑, LDH ↑, LFT: normal. CXR: normal, abdominal and pelvic sonography: normal.

CONCLUSIONS: According to PBS findings the patient treated with IV levofloxacin. Fever and chills resolved after 5 days and treatment changed to oral doxycycline. The patient was afebrile and the weekly PBS showed the organism on blood smear. After 4 week the patient returned to hospital with loss of consciousness and seizure. LP: WBC: 0, RBC: 800, Protein: 90, glc: 60, Brain MRI: normal.

Treatment changed to IV levofloxacin. The patient become awake and alert but the retic was 10% and the PBS showed 3% parasitemia. Treatment changed to doxycycline + gentamycin+ clindamycin the parasitemia decreased to 0.1% but after 3 weeks increased again. Finally the patient was cured using co-trimoxazole for three months.

Keywords: hemolysis, fever, loss of consciousness, unknown organism