Caso para Revisión

El siguiente caso será revisado en clase. El objetivo de la revisión de este caso es llegar al diagnóstico a través de un abordaje clínico correcto y un uso racional de los auxiliares de laboratorio.

“A 50-year-old man was admitted to the hospital be- cause of fever and arthralgias.

The patient had been in excellent health until six weeks earlier, when a sore throat, rhinorrhea, head- aches, and low-grade fever developed. Two weeks lat- er, all the symptoms improved for a few days, followed by a recurrence of fever (peak temperature, 39.4°C), night sweats, and occasional rigors. One week before admission, blood cultures and a tuberculin skin test were negative.

Four days before admission, the patient had pain in the right elbow and knees and pain and edema in the hands and feet. On the next day, laboratory tests were performed (Tables 1 and 2) in the emergency unit of this hospital. The urine was trace-positive for protein. Blood, urine, and throat cultures were obtained, and penicillin V was prescribed for 10 days. The patient’s fever subsided over the next two days, but the pain in his knees and ankles interfered with walking. The sore throat recurred, with pain in the ears and redness of the eyes. He was admitted to the hospital.

The patient managed an apartment building. He had received hepatitis B virus vaccine. He had no his- tory of homosexual contacts, tuberculosis or exposure to it, or contact with ill persons; he did not have pets and had not had any known contact with animals or tick bites.

The temperature was 38.2°C, the pulse was 110, and the respirations were 24. The blood pressure was 120/90 mm Hg.

The examination revealed injected conjunctivae, a small cotton-wool spot in the left retina, mild pharyn- geal erythema, a few crackles at the base of the right

lung, and a grade 2 systolic murmur. There were small effusions in the knees; the knees and shoulders were tender, and the fingers were swollen, with severe pain on passive flexion.”