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Madav,
a 33-year old male government worker from Chitwan, presents
with a 5-week history of fever.
He’s been treated by 3 doctors in clinic, and has a 5-day
admission to the hospital.
Apart from lethargy and mild anorexia, he had no other
symptoms. Written
records reported physical exam being normal, with recorded temperatures
99 – 101.7 0 F repeatedly.
Investigations included WBC and diff, chest X-ray (twice),
blood culture (twice), and malaria smear (three times) – all
normal. Urine once
showed WBC 3-5/hpf, and ALT was mildly elevated.
At
various times, he has been treated with amoxicillin, cotrimoxazole,
chloroquine, ceftriaxone (5 day course), and metronidazole.
None of these seemed to have a prolonged effect in reducing
the fever.
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