Diagnostic Dilemma

Pneumonia with hepatitis responding to clindamycin

A 5½ years old boy presented with recurrent fever and jaundice for 1½ months, with right ankle pain for 7 days. He had Widal positive {0 titre= 1:160} and was treated with cefaperazone for 10 days to which fever responded. However again for past 7 days, he had fever, jaundice and ankle pain. On examination, he had jaundice, hepatomegaly and right ankle cellulitis. He had right infra-mammary crepitations. Investigations showed hemoglobin of 8.6 gm, dl. WBC count of 23,200, cumm {81 percent polymorphs, 17 percent lymphocytes} and CRP of 167 mg, dl with ESR of 101 mm at end of 1 hour. Chest X-Ray showed right lower haziness. Liver functions showed bilirubin of 8.9 mg, dl {direct = 2.6 mg, dl}, SGOT of 208 IU, L, SGPT of 100 IU, L and Albumin of 2 gm, dl. He was started on Cefotaxime and Cloxacillin for 12 days but fever persisted. Blood culture did not grow any organism. He was started on piperacillin-tazobactum and Clindamycin to which fever subsided in next 48 hours and LFT also showed improvement. CRP also decreased to 68 mg, dl.

What is the likely organism_?
Expert Opinion :
This patient has pneumonia, hepatitis and right ankle cellulitis. Thus it does not seem to be due to salmonella. Any other organism_?
Answer Discussion :
Srinivas prasad
13 years ago
akila devic
13 years ago

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