This case report shows the importance of avoiding these cognitive biases by looking further than the common rhinovirus in a patient small for height and weight with
recurrent fevers.
A workup for IMD (chest and sinus CT scan) was triggered in the following situations: persistent (after six days of antibiotics) or
recurrent fever, clinical manifestations of IMD (sinuses, pneumonia, skin nodules), or positive s-GMI (>0.5).
Studies show a family history of
recurrent fever in 10%-60% of patients, and recurrent tonsillitis in one parent is twice as likely among children with PFAPA.
Its symptoms also include
recurrent fever and anemia.
Mevalonate kinase deficiency syndrome (MKD) usually starts in the first year of life and is characterized by lifelong
recurrent fever episodes, typically ranging from 3 to 7 days [23].
A closely related disease is mevalonic aciduria (OMIM 610.377), which is due to a near-total inactivity of the enzyme mevalonate kinase: in this condition,
recurrent fever episodes appear in association with serious systemic signs, such as delayed growth, cranial-facial dysmorphism, microcephalia, cerebellar atrophy, ataxia, psychomotor retardation, retinal dystrophy, and cataracts [108].
This code was also used for malaria fever and
recurrent fever. Fever, relapsing fever, 5-day fever, periodic fever and 3-day fever were queried using 780.6, 087.9, 083.1, 277.31, and 066.0 respectively.
A 12 yr old HIV positive boy from Nagaland, India presented with history of
recurrent fever, cough, weight loss, diarrhoea, and generalised papular, smooth, dome shaped and umbilicated skin lesions of varying size (2-10 mm) of one month duration.
A 53 year old female diagnosed elsewhere in May 2000 as lepromatous leprosy presented at our hospital in September 2000 with a 2-month history of papulonodular eruptions associated with general malaise and
recurrent fever. She was diagnosed with a Type 2 reaction.
The patient does well and is successfully switched to oral amoxicillin/clavulanate (Augmentin) with no
recurrent fever and continued healing of vaginal ulcers.
The availability of a test to detect the most frequent MEFV gene mutations simultaneously should prompt molecular genetics laboratories to investigate patients with
recurrent fever on a routine basis.
Koch was also noted for work in tropical medicine, especially trypanosomiasis,
recurrent fever, typhoid fever, and the rinderpest outbreak in South Africa.
