title: Pulmonary tuberculosis presenting as post-operative fever of unknown origin.
abstract: Post-operative fever is common following emergency surgery. Investigation and management of post-operative fever can be challenging when a clear source of sepsis is not evident or the underlying source of infection is not recognised. We herein report a case of secondary pulmonary tuberculosis presenting as post-operative fever following emergency laparotomy for a perforated duodenal ulcer. This case of tuberculosis was diagnosed on day 41 post-operatively and prior inconclusive results meant that we relied mainly on re-visiting history and examination in order to identify 3 targeted investigations: plain chest X-ray, sputum sample and blood test. Accordingly, the co-management of this complex patient achieved a good outcome.
authors.affiliation: Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.|Department of General Surgery, East Kent Hospitals University NHS Foundation Trust, Margate, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bogue
authors.affiliation: Department of General Surgery, East Kent Hospitals University NHS Foundation Trust, Margate, UK.
authors.forename: Mhairi
authors.initials: M
authors.lastname: Bolland
authors.affiliation: Department of General Surgery, East Kent Hospitals University NHS Foundation Trust, Margate, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: How
authors.affiliation: Department of General Surgery, East Kent Hospitals University NHS Foundation Trust, Margate, UK.
authors.forename: Harrison
authors.initials: H
authors.lastname: Benziger
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004378:Duodenal Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D005335:Fever of Unknown Origin / Q000382:microbiology*; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents