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Fever,hepatic Focal Lesion,adenoma,haemangioma.

Posted on Fri, 5 Oct 2012

Question: Hi Doctor, My wife is 26 years, 167 hight, 71 weight and she has fever sience 6 weeks(can reach temp 39.5-40C without medicin to reduce the High temperature), and when we make CT we have found by luck hepatic focal lesion likely haemangioma, Adinoma, in sigmant 3,,,,(they cannot confirm). also we have CBC with high Neutrophils 85%, and WBCs 0000.
Doctor has said that its FUO+Neotrophils but we made blood culture, urin culture, urin analysis and it was OK, Serum Protein electrophoresis(High GAMMA 1.6), LIVER FUNCTION TESTS its given Gamma GT 127; (negative ADNA, AMA, ASMA).

Could you please explain if Atypical haemangioma,or Adinoma can cause fever, also what is your recommendation in case of fever of unknown origin with neutrophiles?

Thanks in advance for your quick response
Please ask me any questions if you need as i have with me many blood, liver tests may it will help you more if you want.

Answered by Dr. Sapan J. Pandya (2 hours later)

Hi! XXXXXXX

Thanks for your query.

On reading your query,I would like to share my opinion which is as follows

Common tumors in liver may be :
1.Adenoma (fever & neutrophila very rare).
2.Haemangioma (fever & neutrophilia very rare)
3.One more common condition is HYDATID CYST caused by ECHINOCOCCUS GRANULOSUS (fever & neutrophilia very rare).
4.LIVER ABSCESS (Low grade fever with neutrophila)

There is certainly some damage to the liver cells. There is elevated levels of Liver Enzymes.
White Blood Cells are defense cells of the body. Neutrophils increase specifically in bacterial infection. So there is some bacterial infection against which the body defense has become active. Bacteria causing the infection and the antibiotics sensitive to the infection can be found by blood culture and sensitivity report.
Could you scan (1) CT Scan report and (2) blood culture and sensitivity report and send it to YYYY@YYYY SUB:"Attention Dr. Sapan J. Pandya."

I shall answer you better once I see the reports.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (8 hours later)

Hi Doctor,

As per your request kindly find the attached reports,(CT, MRI, BC, Liver tests, you will find CBC with 61% nuetrophils in March 05 and she was ok without Fever and CBC with high Neutrophils starting from April 05-She feel Fever starting from March 29-)
waiting for your comments and hope that you can find exactly the reason for this Fever.

Please be noted that she feel normal in hir boody except the fever.
i would like to add to the sent attached reports and tests some test results i have recieved just now( CRP 169, RF 14, ESR 1st hour 101, 2nd hour 137, urin analysis RBCs 10-15, ADNA negative, ferritin 944 iron serum 26, SGOT 46, SGOT 40)

Answered by Dr. Sapan J. Pandya (9 hours later)

Hi! XXXXXXX
Went through all the reports. Such high ESR is mostly seen in Tuberculosis and Rheumatoid Arthritis.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sapan J. Pandya (2 hours later)

Dear Doctor,

She had done the Tuberculosis and Rheumatoid Tests and its negative,
what do you think regardless the Tuberculosis and Rheumatoid??

we have now Fever with high neutrophils and high ESR and CRP.

Your help is highly appreciatted

XXXXXXX

Answered by Dr. Sapan J. Pandya (5 hours later)

Hi! XXXXXXX

Your wife's diagnosis is between LIVER ABSCESS, TUBERCULOSIS & RHEUMATOID ARTHRITIS.

High neutrophilia, high ESR & high CRP all point towards LIVER ABSCESS.

If it is a liver abscess , antibiotics or a percutaneous or laparoscopic drainage would be needed.

You may have a talk to a GASTROENTEROLOGIST or a INFECTIOUS DISEASE SPECIALIST.

Wish you good health

Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar