A
boy aged 11 years and eight months, coming from the state of Mato Grosso do
Sul, mid-western region of Brazil, was taken to the teaching hospital of the
Federal University of Mato Grosso do Sul with a history of high fever for 8
days, temperature peaking 40°C, especially in the evening and night. The febrile
episodes lasted for about 2-3 hours, slightly easing with the use of
antipyretics, and were followed by sweating and fatigue during defervescence.
Also noticed were prostration, appetite loss and weight loss (approximately 2
kg in a week), in addition to diarrhea, vomiting and diffuse abdominal pain.
Physical examination presented HR (heart rate) = 120 bpm, RR (respiratory rate)
= 36 rpm, axillary temperature = 39.5°C, weight = 27 kg. The patient was pale,
anicteric and showing intense prostration.
The cardiopulmonary examination
showed no noteworthy changes. He presented abdominal distension and relevant
visceromegaly, with liver palpable at 6 cm below the RCM and 10 cm from the
xiphoid process, very painful, and spleen at 4.5 cm below the left costal margin,
painless. Both viscera occupied all mesogaster and hypochondria. The
extremities showed no edema, and good peripheral perfusion was seen. The
results of blood count and biochemical tests were: hemoglobin concentration =9.3 g/dL, hematocrit = 28%, leukocytes = 2900 mm3 (band neutrophils, 4%,segmented neutrophils, 61%, eosinophils, 3% lymphocytes, 29% monocytes 3%),
platelet count = 150,000, sodium = 136 mmol/L, potassium = 4.4 mmol/L, urea =
49 mg/dL, creatinine = 0.8 mg/dL; AST = 54 U/L, ALT= 80U/L, TP = 5.9 g/dL, Alb
= 2.5 g/dL, Globulins = 3.4 g/dL; TB = 0, 55 mg/dL, DB = 0.13 mg/dL, IB = 0.42
mg/dL. The occurrence of fever, pallor, hepatosplenomegaly, anemia and
leukopenia has initially led to the diagnosis of visceral leishmaniasis (VL),
since this disease is endemic in the state of Mato Grosso do Sul.
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