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[Clinical thinking and decision making in practice. A patient with persistent fever]
R P Koopmans1, I Baas, M C Schreuder
1Academisch Medisch Centrum, afd. Inwendige Geneeskunde, AZ Amsterdam. r.p.koopmans@amc.uva.nl
Nederlands Tijdschrift Voor Geneeskunde
|August 15, 2000
Summary
A patient with multi-drug resistant typhoid fever developed persistent symptoms despite cefotaxime treatment. Discontinuation of the antibiotic led to symptom resolution, suggesting drug fever as the cause.
Area of Science:
- Infectious Diseases
- Pharmacology
Background:
- Typhoid fever, caused by multi-drug resistant Salmonella typhi, presents a significant treatment challenge.
- Travel to endemic areas like India increases the risk of contracting resistant strains.
Observation:
- A 20-year-old male presented with persistent fever and malaise following travel to India, diagnosed with multi-drug resistant typhoid fever.
- Despite in-vitro sensitivity and 7 days of cefotaxime treatment, the patient experienced continued fever, shivering, and liver enzyme abnormalities.
Findings:
- Cessation of cefotaxime therapy resulted in the complete disappearance of all symptoms and signs.
- The clinical presentation and resolution upon drug withdrawal strongly indicated drug fever as the cause of the persistent symptoms.
Implications:
- Drug fever should be considered in patients with persistent symptoms despite appropriate antimicrobial therapy for infections like typhoid fever.
- The diagnostic approach involving dechallenge and rechallenge is crucial for identifying drug-induced fever.