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Postsplenectomy infection syndrome - A differential diagnosis of cervical soft tissue inflammation?
Introduction: A 56-year-old man presented B-symptoms, high fever, weight loss, unilateral, pronounced neck swelling and a change in the pharyngeal sidewall . Condition after splenectomy, little or no toxins, socially respected personality. CRP 64: leukocytes: 11.9 / nl, sonography without melting of the lymph nodes.
History and treatment I.v. Treatment with Amoxicillin / Sulbactam, without significant improvement, nevertheless undulating fever curve. Blood cultures negative, after switching to Piperacillin Tazobactam developement of a whole body exanthem. MRI control after 5 days with evidence of fusion and alteration in the oropharynx,histologically inflammatory desease; biopsy neck in abscess cleavage: Granulomatous inflammation TBC possible.
Thereupon serology HIV, Hepatitis B and Quantiferon negative; then serological detection of IgM Treponema pallidum. Completion of antibiotic treatment and history, the patient can imagine a primary effect in the pharynx. Consistent continuation of antibiosis, complete healing.
Summary / Assessment In the first place, suspected of having a postplenectomy syndrome, we suspected an immune deficiency and a bacterial infection as well as, in particular, histology and radiological findings, tuberculosis. The specific infection could be confirmed by serology with TPHA, which also explains the typical skin lesions and B symptoms, as well as the tumorous plaque in the oropharynx. We therefore recommend that you use the 19S IgM fluorescence Treponema antibody test, which is particularly specific, knowing full well that the incidence of syphilis increases.
10 June 2020 (online)
© Georg Thieme Verlag KG
Stuttgart · New York