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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Is The Treatment For Elevated Bilirubin Level, Jaundice, Arthritis And Fever With Dry Skin, Swollen Lips And Weakness?

Kindly provide differentials on this case: 15 year old female, cc fever x 3 days, dry swollen lips, dry skin on face, slightly flushed and upper half of the body, generalized weakness & body pains. Starting having elevated bilirubin levels after week 2 of admission, jaundice & continuing fever of unknown origin. This was followed by difficulty of respiration with O2 sats dipping to 84-92% on room air, currently maintained on O2 at 4L/min to maintain 100% sats. No cough, no signs of respiratory infection on imaging studies. An initial diagnosis of Rheumatoid Arthritis was given 2 weeks prior to admission. Rule out SLE, but labs not supportive.
Thu, 12 Dec 2013
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Cardiologist 's  Response
Dear user:


Difficult case for sure; the main categories for differential diagnosis would be infectious (eg. Epstein Barr, cytomegalovirus, etc), inflammatory and autoimmune (Hemophagocytic syndrome, Stills disease, SLE, mixed connective tissue disorder) and rarely malignant (eg. lymphoma).

A bone marrw biopsy with special stains may be indicated.


Hope this helps, wish you the best,

Dr Brenes-Salazar MD
Mayo Clinic
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What Is The Treatment For Elevated Bilirubin Level, Jaundice, Arthritis And Fever With Dry Skin, Swollen Lips And Weakness?

Dear user: Difficult case for sure; the main categories for differential diagnosis would be infectious (eg. Epstein Barr, cytomegalovirus, etc), inflammatory and autoimmune (Hemophagocytic syndrome, Stills disease, SLE, mixed connective tissue disorder) and rarely malignant (eg. lymphoma). A bone marrw biopsy with special stains may be indicated. Hope this helps, wish you the best, Dr Brenes-Salazar MD Mayo Clinic