[Clinical thinking and decision making in practice. A patient with persistent fever].
A 20-year old man was admitted to hospital with fever and malaise after travel to India. He was soon found to have typhoid fever, caused by a multi-drug resistant Salmonella typhi. According to in-vitro resistance testing he was treated with cefotaxim, but fever and shivering were still present after 7 days of cefotaxim, with liver enzyme disturbances. The physicians caring for him started an extensive search for possible complications of typhoid fever, and they thought of the possibility of an alternative disease to explain the fever. When cefotaxim was stopped all symptoms and signs disappeared. During every medication, drug fever is a possibility. This diagnosis can only be supported by discontinuing the use and if necessary, restarting it (dechallenge and rechallenge).
Koopmans
R P
RP
Academisch Medisch Centrum, afd. Inwendige Geneeskunde, AZ Amsterdam. r.p.koopmans@amc.uva.nl
Baas
I
I
Schreuder
M C
MC
Hart
W
W
D000328:Adult; D002439:Cefotaxime / Q000009:adverse effects*; D002511:Cephalosporins / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005334:Fever / Q000139:chemically induced*; D006801:Humans; D008297:Male; D012485:Salmonella typhi / Q000302:isolation & purification; D014435:Typhoid Fever / Q000175:diagnosis* / Q000188:drug therapy*
D002511:Cephalosporins; D002439:Cefotaxime