title: Fibrin ring granulomas in Rickettsia typhi infection.
abstract: We describe a 71-year-old man hospitalized for fever and productive cough. Laboratory investigation showed anemia, thrombocytopenia, elevated transaminases, hyponatremia, and hypoalbuminemia. Computerized tomography of the abdomen, thorax, and sinuses, echocardiography, and a gallium scan did not reveal the source of the fever. The patient remained febrile despite courses of piperacillin-tazobactam/azithromycin and ceftriaxone/vancomycin. A bone marrow biopsy showed fibrin ring granulomas, and 2 rickettsial serologic panels were positive for Rickettsia typhi infection and negative for Q fever. The patient was given doxycycline, and the fever resolved within 48 h. We propose that fibrin ring granulomas also occur in murine typhus.
authors.affiliation: Veterans Evidence Research Dissemination and Implementation Center (VERDICT), South Texas Veterans Health Care System, San Antonio, TX 78229, USA.
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Restrepo
authors.forename: E Martin
authors.initials: EM
authors.lastname: Vasquez
authors.forename: Carolina
authors.initials: C
authors.lastname: Echeverri
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Fiebelkorn
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Anstead
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001853:Bone Marrow / Q000382:microbiology* / Q000473:pathology; D003937:Diagnosis, Differential; D004318:Doxycycline / Q000627:therapeutic use; D006099:Granuloma / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D008297:Male; D012286:Rickettsia typhi / Q000302:isolation & purification*; D014437:Typhus, Endemic Flea-Borne / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline