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Have Intermittent low-grade high fever. History of depression and schizophrenia. Liver function test came normal

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WE ARE LIVING IN NEW DELHI INDIA AND MY SON NOW 26 YEARS OLD WEIGHT 48 KG IS HAVING INTERMITTENT LOW GRADE TO HIGH FEVER FEVER FOR SINCE CHILDHOOD . HE IS DELAYED MILESTONE CHILD AT THE TIME OF BIRTH BUT NOW HE IS ALMOST NORMAL. HE IS COMPLAINING OF STOMACH PAIN FOR LAST TEN YEARS . HE IS PRONE TO SIDE EFFECTS OF ALLOPATHIC MEDICINES. WE WENT TO A PRESTIGIOUS DOCTOR ABOUT 5 YEARS BACK AND HE ADVISED FLUDAC . WITH VERY FIRST DOSE OF FLUDAC HE WENT INTO DEPRESSION / SCHIZOPHRENIA . . FOR THE THE TREATMENT OF DEPRESSION WE WENT TO A GOOD PSYCHIATRIC DOCTOR AND ON HIS ADVISE HE WAS GIVEN OLIZA/ SERENATE . WITH FIRST DOSE HE GOT AN ATTACK OF EPILEPSY . ALL THIS I AM WRITING TO TELL YOU ABOUT HIS HISTORY AND MISDIAGNOSIS. HE HAS BEEN REPATEDLY GIVEN ANTIBIOTICS FOR HIS FEVER ATTACKS. NOW APART FROM HIS INTERMITTENT FEVER , HE IS LOSING WEIGHT , HAVE NIGHT SWEATS , REPEATED ATTACK OF COUGH / PHLEGM , MILD STOMACH PAIN . ALL HIS BLOOD TESTS , LEVER FUNCTION TEST / ANTI GLUCON TEST / WHOLE ABDOMEN ULTRA SOUND / CHEST X RAYS ETC. ARE ALL CLEAR . WHAT IS THE CASUE OF HIS DISEASE . AFTER READING A ARTICLE IN THIS FORUM I AM SUSPECTING HIM OF TB. WHAT IS YOUR OPINION . HE ( SON ) IS FED UP GOING TO THE DOCTORS AND IS NOT COOPERATING. WHAT SIMPLE TESTS CAN CONFIRM HIS DISEASE / TB . AND CAN THE TB DRUGS BE STARTED AS PER HIS SYMPTOMS ON SHORT TERMS ON TEST / TRIALS BASIS WITHOUT GOING THROUGH COMPLICATED TESTS OF CT SCANS ETC./ TO AVOID FREQUENT VISITS TO THE DOCTORS . WHAR ARE PRECAUTIONS AND FOOD INTAKE . PLEASE SUGGEST IN DETAILS
Posted Tue, 2 Apr 2013 in Digestion and Bowels
 
 
Answered by Dr. Charles S Narasi 7 hours later
Hello, XXXXXXX XXXXXXX XXXXXXX
I can understand your frustration about the long history
of problems involving your dear son. From your description
and reports, routine blood work, x-rays, sonogram have all
been normal. His low grade fever especially at night times
is suspicious of some ongoing infection . I agrre with you
that T.B. has to be ruled out. In addition to having sputum
tested for T.B. Bacillus , he probably needs blood and bone
marrow cultures done to detect infection. In testinal T.B.
is sometimes hard to diagnose. If he has not had small
intestinal and large bowel x-rays , he needs these. An
upper GI endoscopy with biopsy and also a colonoscopy
to look at the ileo-cecal area (Junction of large & small bowel).
Multiple stool examinations for ova and parasites have to be done,
if not already done. I am also concerned about his weight loss.
If he has any swollen glands in the neck or under arm , a biopsy
of the lymph node is in order to rule out lymphoma or Hodgekins.
Auto-immune diseases such as systemic Lupus have to be ruled
out through special blood tests.
Hope you can discuss these with the doctor and proceed from there.
I wish him the very best.
Above answer was peer-reviewed by
 
Follow-up: Have Intermittent low-grade high fever. History of depression and schizophrenia. Liver function test came normal 23 hours later
I appreciate your advise and will discuss it with a local doctor but I had specifically requested you that since patient is not cooperating ,please suggest specific blood test Along with THEIR METHOD AND as GI endoscopy and colonoscopy is at presently not possible at this stage as such I had requested you some symptomatic treatment for ( INTESTINE TB/ ? ) that can be safely given for a certain period and on the response of these drugs further course of action could be evaluated to avoid the hassles of all these ct scan endoscopy / colonoscopy . also please suggest diet and and vitamin and diet absorbing supplements . we are strictly vegetarian . Following are some of his test reports which may help you to arrive to some conclusion

1.) ECHOCARDIOGRAHPHY AND COLOR DOPPLER REPORT done on 9th feb. 2013

IMAGING ; 1. ? Ssmall VSD just above the aortic valve . no PAH

2. LA normal in size , no clot

3. RA not dilated .

4. MItral valve shows mild response of AML ,PML normal , no MAC

5. no pericardial effusion noted

COLOR FLOW IMAGING

Normal flow across the valve .

FINAL IMPRESSION

1. ? small VSD just above the the aortic valve . No PAH

2. No RWMA

3. LV ejection fraction 63 %

4. Mild prolapse of AML noted

5. Normal LV diastolic function

7. Normal flow across the valves

8. No pericardial effusion noted




2. ) LUNG FUNCTION TEST done on 9th feb. 2013



Diagnosis

Obstructive abnormality ; MIld ( FEVI < 100% of Predicted value and FEVI > = 70 % OF Predicted value

Restrictive abnormality ; Moderate ( FVC < 70 % of Predicted value and FVC > = 60 % OF Predicted value


3.) X-RAY CHEST ( PA ) DONE ON 24-01-2013

Both apices are clear

No definite active parenchymal lesion seen

Both CP angles are clear

Cardiac shadow is normal

Bony cage appears normal

IMPRESSION

No definite abnormality detected

4.) X - XXXXXXX PNS

Both frontal sinuses are clear

Both maxillary antra showsevidence of mucosal thickening , no definite air fluid level

Minimal hypertrophy of intranasal seen , septum is in middle

IMPRESSION

Both maxillary antra shows mucosal thickening


5.) ULTRA SOUND TEST DONE ON 24-01-2013

WHOLE ABDOMEN

Liver span and echotexture is normal . No definite focal mass lession or IHDD seen

Portal vein is normal in caliber . COMMON duct 4.1 mm is normal in caliber , terminal end is obliterated

Gall Bladder is normal in size and shape , wall thickness is normal , lumen is echofree

Pancreas appears normal sonographically , tail is obscured by bowel loops.

No definite para-arotic lymph node seen.

No definite spleenomegaly or fluid seen .

Both Kidneys are normal in size and shape , CMD IS WELL MAINTAINTED. No hypronephrotic changes see
Right kidney measures 94 mm and left kidney measures 104 mm in length .

Urinary bladder shows no lifting defect and back pressure changes.

Prostate is normal in size ( 28 x 30.6 x 37 mm ) , volume being 17.1 gms and echotexture . PERIPROSTATIC
tissue is well maintained .

IMPRESSION

No definite abnormality detected.


6.) THYROID PROFILE DONE ON 25-01 -2013

NORMAL RANGE

FREE T3 ; 4.6 pg/ mL 1.8 - 5.0

FREE T4 ; 1.7 ng/ dL 0.8 - 1.9

TSH ; 0.5 ulU /mL 0.5 -5.0



7.) BLOOD GLUCOSE FASTING TEST DONE ON 09-02-0000

81.00 mg / dL 60 - 100

8.) ANTI TISSUE TRASGLUTAMINASE ANTIBODY ( IGA )

Tissue transglutaminase Iga antibody assay ( human recombinant ) ; 8.70 uy / mL

interpretation ;

NEGATIVE Less than 20.0 U /mL

POSITIVE More than 20. 0 U/ m L


IMMUNOGLOBULIN ASSAY

REFRENCE RANGE

IgA ( TOTAL ) 338.00mg / dL 70 - 400




9.) IMMUNO ASSAYS TEST DONE ON 02-09-2008


IGM TO A60 MYCOBACTERIUM ( ELISA )

A60 TB TEST - BORDERLINE

A60 TB TEST ( NORMALISED VALUE ) - 0.92


in view of the antigenic cross reactivity and the limited Indian Studies available , the test reported has to be co-related clinically.

INTERPRETATION.

NORMALISED VALUE INTERPRETATION

Less than 0.8 NEGATIVE

0.8 to 1.0 BORDERLINE

More than 1.0 POSITIVE


IGG T0 A60 MYCOBACTERIUM ( ELISA )


A60 TB TEST 2.20 U /mL


INTERPRETATION

Less than 1.25 U/mL NEGATIVE

1.25 TO 2.25 U/mL EQUIVOCAL

More than 2.25 U/mL POSITIVE.


10.) VITAMIN D , 25 HYDROXY ( CLIA ) TEST DONE ON 28-04- 2012


153 .0 0 nmol /L ( AFTER TAKING VITANMIN D DOSE OF ONE MONTH )
 
 
Answered by Dr. Charles S Narasi 2 days later
Hi,

I am sorry for the delay in my response. I have read your follow up query in depth. Thanks for writing out the reports.

Here is my conclusion:

1. A small VSD above the aortic valve is not significant. It can be watched upon. No intervention is required for it as of now.

2. His lung function test shows that there is moderate restrictive abnormality in his lungs.

3. Thickening in the maxillary sinuses. Nothing needs to be done for this as well.

4. The immunoassays done on 02/09/2008 show a borderline positive test for IgM and equivocal for IgG. The test may be considered almost positive. Was there any follow up test done for this after 2008?

5. Rest of the reports is normal.

Going by all these tests and his symptoms, I narrow down the possibilities to Tuberculosis (TB) or a Lymphoma.

Diagnosis of either of them is easy by clinical examination and a few specific tests.

Here are my suggestions:

-Repeat the IgG and IgM test for TB.
- A good clinical examination to check for the lymph nodes. If found enlarged, a biopsy can be taken to test for lymphoma.
- There is no harm in starting him on a trial of anti-TB medicines for a couple of months and look for improvement.

Hope this helps you to take a decision.

Regards,


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