37-years-old man with fever, jaundice, abdominal pain and distention
| Abstract Title: | 37-years-old man with fever, jaundice, abdominal pain and distention |
| Authors: | Veronica Grec, Alin Frentiu, Adrian Wiener, Liana Mos, Corina Zorila |
| Affiliation: | “Vasile Goldis” Western University Arad, Romania Clinic Municipal Hospital Arad, Romania |
| Abstract text: | The case presented is of a patient aged 37 years, without significant pathological medical problems at first hospitalization for a prolonged fever developed undulating onset of approximately two months before admission, interpreted as a background intercurrent infectious syndrome ascito-oedematous of unknown etiology. The patient was hospitalized with fluffy edema of the lower limbs and abdominal wall, heavily scleral jaundice with itching and sore skin scraping, large hepatomegaly sensitive to palpation, splenomegaly, and mild amount of ascites fluid, oligoanuria, foetor hepaticus and feverish. The emergency upper endoscopy showed esophageal varices grade 2 and the ultrasound confirmed the mild amount of ascites fluid and an important hepato-splenomegaly. Transthoracic echocardiography was normal and no changes on EKG. Diagnosis at admission was the cholestatic liver cirrhosis Child-Pugh class C with feverish syndrome being interpreted in the context of active progressive liver disease, rapidly progressing to terminal hepatic coma. The clinical and paraclinical etiologic diagnosis was most likely primitive sclerosing cholangitis. Necropsy confirmed the diagnosis of decompensated liver cirrhosis, macronodular form and the presence of a small vegetation on aortic valve with aortic atherosclerosis and coronary lesions. The particularity of the case was the diagnostic in the end-stage of the liver disease, the association of the subacute bacterial endocarditis without apparent cause of bacteremia, probably in the context of secondary immune-depression syndrome severe liver disease with the severe coronary atherosclerotic early type, precipitated by the chronic cholestatic syndrome. |
| Keywords: | fever, jaundice, abdominal pain, distention |
| Presentation type: | Oral |
| Correspondence: | no. 1 Nalbei St., Arad, Romania |
| Email: | vero_grec2007@yahoo.com |
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