Table 1.
Comparison of characteristics during the three admissions.
| Admission number 1 | Admission number 2 | Current admission | |
|---|---|---|---|
| Presentation | Fever and sore throat | Fever, neck stiffness, cough, macular rash with whitish central papules on chest and extremities | Fever, gluteal abscess |
|
| |||
| WBC (ANC) | 2.8 k/uL (600 cells/uL) | 1.9 k/uL (100 cells/uL) | 1.3 k/uL (100 cells/uL) |
|
| |||
| Platelets lowest | 176 k/uL | 53 k/uL | 33 k/uL |
|
| |||
| Urine toxicology | Cocaine and cannabinoids | Cocaine | Cocaine and cannabinoids |
|
| |||
| Imaging | Chest X-ray-negative | Chest X-ray-negative | Chest X-ray-negative |
| Chest CT negative | CT head-negative | ||
| Abdomen/pelvis CT-possible colitis | CT facial bones negative | Abdomen/pelvis CT-perianal abscess | |
| Echocardiogram-normal | Echocardiogram-normal | ||
|
| |||
| Serology-negative | HIV-negative Thyroid panel-normal Cardiac markers-negative |
HIV, HTLV, BCR-abl, malaria smear, dengue titer, hepatitis panel serum cryptococcal antigen, collagen vascular disease work-up negative, RPR | ANCA, ANA, MPO, antiphospholipid antibodies, anti-cardiolipin, complement, HLA B27, malaria, hepatitis, HIV, HTLV-all negative |
|
| |||
| Other tests | Flow cytometry neg. | Flow cytometry neg. | |
|
| |||
| Urine and serum for levamisole | Not done | Not done | Sent at day 5 of admission-negative |
|
| |||
| Cultures-blood, urine, stools | Negative | Negative | Negative |
|
| |||
| Procedures | None | Spinal tap normal | Perianal abscess drainage at the bed side |
| Bone marrow biopsy ×2 (hypercellular marrow with myeloid predominance and trilineage maturation) | |||
|
| |||
| Antibiotics | Ciprofloxacin Metronidazole Moxifloxacin |
Vancomycin, meropenem, acyclovir, fluconazole, doxycycline, daptomycin, metronidazole, cefepime, clindamycin | Vancomycin, cefepime, Zosyn, caspofungin, amikacin, and meropenem |
|
| |||
| G-CSF (duration-days) | Not given | 5 days of administration | 8 days of administration |
|
| |||
| Others | Platelets transfusion | ||
|
| |||
| Hospital complications | None | None | Acute renal failure. Serum Creatinine 1.4 → 2.9 → 4.4 |
| Gastrointestinal bleeding | |||
|
| |||
| Fever resolution-time days | 2 days | 8 days | 7 days |
|
| |||
| Outcome | Discharged after 4 days-symptoms improved | Discharged after 23 days-symptoms improved | Discharged after 16 days-symptoms improved, abscess healing |
ANA = antinuclear antibodies; ANCA = antineutrophil cytoplasmic antibodies; HIV = human immunodeficiency virus; HTLV = human T-lymphotropic virus; MPO = anti-myeloperoxidase; human leukocyte antigen B27.