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Case Report
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| A fever of unknown origin as a presenting symptom in toxoplasmosis: Back to earth | ||||||
| Jill F. Mentink1, Michiel van Rijn2, Adriaan Dees3 | ||||||
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1MD, Resident, Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands.
2MD, PhD, Microbiologist, Department of Microbiology, Ikazia Hospital, Rotterdam, the Netherlands. 3MD, PhD, Internist, Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands. | ||||||
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| How to cite this article |
| Mentink JF, van Rijn M, Dees A. A fever of unknown origin as a presenting symptom in toxoplasmosis: Back to earth. Int J Case Rep Images 2017;8(1):73–76. |
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Abstract
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Introduction:
Fever of unknown origin (FUO) and weakness in the upper legs are among the presenting symptoms in acute toxoplasmosis, which can occur in immune-competent individuals.
Case Report: A 76-year-old Caucasian male presented at the hospital with relapsing fever and weakness in both upper legs. A neurological examination confirmed weakness in the quadriceps muscles, which appeared to be atypical for any neurological substrate. An extensive work-up did not lead to a diagnosis. After two weeks of clinical investigations and persistent fever, we re-examined our patient to look for anamnestic signs. We again asked about (recent) vacations, hobbies and potential exposures. Ultimately, the patient told us he performed charity work at a care farm for more than ten years. He had contact with sheep and soil, which occurred while working in the garden without wearing gloves. A diagnosis of a primo toxoplasmosis infecton was made and the patient was treated with daraprim and clindamycin. Within two days his temperature normalized and the strength in his legs improved gradually. He achieved a complete recovery within three months. Afterwards his wife mentioned that her husband was afraid of losing his volunteer job, when telling his doctors about his work with disabled people. Conclusion: In patients presenting with FUO, clinicians in search of a diagnosis must struggle through a long list of possible diagnosis. Diagnostic delay can be shortened by considering the potential clues in the patient's history. | |
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Keywords:
Diagnostic delay, Fever of unknown origin (FUO), Toxoplasma gondii
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Author Contributions
Jill F. Mentink – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Michiel van Rijn – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Adriaan Dees – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2017 Jill F. Mentink et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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