Pearls from 2/15/2022 LEADS

The February 15, 2022, session of Duke Medicine LEADS featured Timothy Hopper, MD, Sitharthan Sekar, MD, Ryan Keane, MD, Thomas Holland, MD presenting on "Mysterious Febrile Illness in a Returning Traveler." 

Pearls

  1. The diagnostic schema for fever in a returning traveler should take into consideration both travel related and travel unrelated etiologies. In addition to location, exposures and host related factors including immune status are essential to consider. Finally, incubation time is important to consider, particularly for travelers returning from the Caribbean and can suggest infectious etiologies with shorter incubation period (<10 days: Leptospirosis, Rickettsial disease, Dengue, Zika, Chikungunya) from those with longer incubation period (>10 days: Tuberculosis, Q-fever, HIV, Histoplasmosis) or those which can present in either window (Typhoid fever or Malaria).  

  2. Etiologies of pancytopenia can be broken down into bone marrow infiltration, bone marrow failure or peripheral destructive or consumptive processes. Multiple viral infectious etiologies are associated with bone marrow suppression including HIV, EBV, CMV, HCV and Parvovirus B19.

  3. Gelatinous transformation of the bone marrow (GMT) also known as serous fat atrophy is a rare condition characterized by extracellular deposits of gelatinous material rich in hyaluronic acid in the bone marrow. The primary underlying contributor to GMT is thought to be malnutrition. Additional etiologies include anorexia nervosa , acute febrile states, AIDs and other chronic infections, alcohol abuse, lymphoma, rheumatologic disease including systemic lupus erythematosus, endocrinopathies, carcinomas and chronic heart disease. Treatment should be focused on re-nourishment with consideration for supportive management with hematopoietic growth factors while awaiting improvement from nutrition. Anticipated timeline for improvement is unclear but may take months.

 

Watch the recorded session

Duke Medicine Learning, Education, and Discussion Series (LEADS) takes place each Tuesday at 12 p.m. Learn more and see schedule of upcoming sessions.

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