HingKiu Chan MS4 HPI 21 yo man with history of Crohns disease on immunosuppressive medications transferred from OSH presents with 3 weeks of fever and new lesions found on MRI Associated symptoms include headache nausea nonbilious vomit back pain decrease appetite RLQ pain that radiat ID: 690957
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Fever of unknown origin with liver lesions
HingKiu Chan, MS4Slide2
HPI
21 y.o man with history of Crohn’s disease on immunosuppressive medications transferred from OSH presents with 3 weeks of fever and new lesions found on MRI. Associated symptoms include headache, nausea, non-bilious vomit, back pain, decrease appetite, RLQ pain that radiates to RUQ. Labs show transaminase. Blood and urine culture NGTD. No previous hx of PSC. Slide3Slide4Slide5Slide6Slide7Slide8Slide9Slide10Slide11
DDX
Fungal infection
Lymphoma
Cholangiocarcinoma
PSC
Metastatic diseaseSlide12Slide13Slide14Slide15Slide16Slide17
Diagnosis
Disseminated Histoplasmosis
Urine antigen was positive
Patient’s condition is mild/moderate and required 12 months of Itraconazole treatment and may need prophylaxis in the future
Patient was discharged the next day