Dealing with a Mysterious Condition

Businessman on internaional trip airlifted to
bring him home and get treated

THE CASE

A 61 year old businessman was brought to Nanavati Super Speciality Hospital, Mumbai with a history of high-grade fever, minor breathlessness, debilitating joint pains associated with signifi cant swelling for a few weeks. In the previous 30 days, the patient had been travelling internationally to Paris and then to Sri Lanka for businessrelated work. He developed the fi rst fever spike while in Paris and was treated there on an OPD basis with only partial relief. A few days later, he needed hospitalisation for recurrence of fever and breathlessness in Sri Lanka.

He was found to have normal CBC, elevated CRP, Atrial Fibrillation and Left Bundle Branch Block (LBBB) with preserved Ejection Fraction (EF) and interstitial shadows in both lung fi elds on CT chest. He was investigated for Atypical Pneumonia, but no cause was found. He did not respond to higher antibiotics, amiodarone and supportive treatment and, hence, was airlifted to Mumbai after 4 days. The patient was fi rst admitted to another tertiary care hospital in Mumbai where he continued to have fever spikes and dyspnoea with signifi cant worsening of joint pains.

As his fever and infective markers were worsening, his antibiotics were stepped up to vancomycin and meropenem with no relief to his symptoms. At this point, he was referred to Nanavati Super Speciality Hospital with extensive investigations for pyrexia of unknown origin that had not revealed any specific cause.

In view of his recent history of travel, recurrent fever spells, Cardiac Arrhythmias and Oligoarticular Arthritis, a diagnosis of Lyme’s disease was considered. His higher antibiotics were stopped and the patient was put on Doxycycline. Simultaneously, his borrelia burgdorferi IgM was obtained, which was strongly positive.

THE RESULT

Within 2 to 3 days, the fever and synovitis showed signifi cant resolution and the patient was discharged. The recovery was rather uneventful. The patient was advised for a follow-up visit after two weeks. During the follow-up, doctors observed no fever and joint pains even after stopping the NSAIDs. The patient could resume his normal routine without any diffi culty.

Dr. Harshad Limaye

Dr. Harshad Limaye
Sr. Consultant
Internal Medicine
Nanavati Super Speciality
Hospital, Mumbai





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