title: [Clinical thinking and decision making in practice. 4 times ERCP, 6 times ultrasonography of the upper abdomen and 3 CT-scans for a woman with recurrent fever and bacteremia].
abstract: A 42-year-old woman was hospitalised due to recurrent fever (40 degrees C) and bacteraemia. A physical examination revealed no abnormalities. Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca and Enterococci were found in blood cultures. Laboratory results revealed liver enzyme levels which were only slightly elevated. An X-ray investigation, ERCPs, CT scans, ultrasounds, a leucocyte scintigram and a gallium scan, all revealed no abnormalities. Due to the results from the blood cultures it was thought that the bile duct system or the digestive tract were the focus of infection. Therefore a liver biopsy was carried out for the purpose of making a diagnosis. The patient was diagnosed as having ductal plate malformation, a microscopic congenital cystic dilatation of the bile ducts. The prognosis is poor and the treatment consists of lifelong antibiotics.
authors.affiliation: Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Inwendige Geneeskunde, Meibergdreef 9, 1105 AZ Amsterdam.
authors.forename: S E
authors.initials: SE
authors.lastname: Rompelman
authors.forename: W
authors.initials: W
authors.lastname: Hart
authors.forename: R P
authors.initials: RP
authors.lastname: Koopmans
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000382:microbiology*; D001653:Bile Ducts, Intrahepatic / Q000002:abnormalities* / Q000000981:diagnostic imaging; D001707:Biopsy, Needle; D016767:Caroli Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000382:microbiology*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000201:enzymology / Q000473:pathology*; D011379:Prognosis; D055502:Secondary Prevention; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
vernacular_title: Klinisch denken en beslissen in de praktijk. 4 maal ERCP, 6 maal echografie van de bovenbuik en 3 CT-scans bij een vrouw met recidiverende koorts en bacteriëmie.