Unfolding a Clinical Enigma: From a Tibia Fracture in Congo to Mysterious Symptoms
A Case Challenge study of a 58-year-old female who, after sustaining a tibia fracture in the Democratic Republic of Congo (DRC), started experiencing persistent fatigue, abdominal bloating, and elevated eosinophil counts, ignites a journey into the intricacies of infectious disease diagnosis and management. After reading, what’s your diagnosis?
- The woman presented with fatigue, abdominal bloating, and eosinophilia, eight months post tibia fracture in the DRC
- The patient’s eosinophil count had escalated to 3,530 per microliter, significantly beyond the normal reference range (0-400), whereas it had been normal 18 months earlier.
- Following her leg injury, her pre-existing symptoms of weight gain and fatigue intensified; she gained 13.6 kg and started taking afternoon naps due to fatigue.
- Calcified lesions in the right lung, liver, and spleen, suggestive of granulomatous disease, were revealed in a CT scan, along with a probable hepatic cyst.
- Tests for common infections, such as syphilis, HIV, and strongyloidiasis, returned negative results.
- Blood tests for thyroid, kidney, and liver functions were within normal limits, and a test for Lyme disease was also negative.
- The patient had a history of chronic migraines and hyperlipidemia, with no significant past of fever, abdominal pain, or arthralgias.