Monday 1 November 2021

18 M FOU with Seizure

18 year old male, he had his first seizure at the age 5 when he was having High fever. By the age of 18 now he had 10 such episodes of seizure. 

He gets this high fever every 3-6 months and temperature goes to 103-104 degree fahrenheit. He had adenoidectomy and Tonsillectomy 6 years back to prevent these recurring fever but it didn't help. Currently he is having similar fever again. 


For his seizure he had
- Valparin - 2008
- Tegrital-2012
- Levipil-2013
and currently he takes Levipil (levetiracetam) and since it started there were no more seizure episodes.
He used to get hospitalized after seizure episodes and neck rigidity used to be there so csf analysis was done which had nothing significant, neither any pathology found in MRI and EEG. 
Severe Proteinuria happens during hospitalization phase which goes back to normal on recovery.
Usually after 24 to 48 hrs of fever seizure happens.
Sodium Valporate was taperd and stopped in 2010 ,but 2 months after that  he again developed seizures without fever, Again in 2013  levipil  was stopped but the following day he developed an episode of so the dosage was increased and we were advised to continue  the medication further. These were the two instances when he got the episode without fever


- CRP 273.6 mg/L
- Total WBC count 15500
- Pro-calcitonin - 5.44
- Dengue - nagative
- Malaria - negative
- Protein in urine - +++
- 24 hr urine protien - 2488.5 mg/24hr (urine vol. 1500 ml)  
- Random urine protien - 165.9


Current Fever chart - 




Timeline - 





These pics are a list of differentials from Isabel software: with simple query, not having much clinical history details







this is again isabel software output but after detailed clinical history

Query Details
Age: Young Adult 17-29 yrs
Gender: Male
Pregnancy: Not-specified
Region: Southeast Asia
Query Text: apthous ulcers|fever of unknown origin|recurrent fever|back pain|proteinuria|tonsillitis|pharyngitis|seizures

Brucellosis INFECTIOUS DISEASES
Coronavirus INFECTIOUS DISEASES
Relapsing Polychondritis RHEUMATIC DISEASES
Infectious Mononucleosis INFECTIOUS DISEASES
Bartonella Infection INFECTIOUS DISEASES
Cytomegalovirus INFECTIOUS DISEASES
Lyme Disease INFECTIOUS DISEASES
Toxoplasmosis INFECTIOUS DISEASES
Non-Hodgkin Lymphoma NEOPLASTIC DISEASES
PFAPA Syndrome RHEUMATIC DISEASES
Steven-Johnson Syndrome DERMATOLOGY
HIV / AIDS INFECTIOUS DISEASES
Aplastic Anemia HEMATOLOGY
Inflammatory Bowel Disease GASTROINTESTINAL DISORDERS
Chikungunya INFECTIOUS DISEASES
Nephrocalcinosis NEPHROLOGY
Adult Still Disease RHEUMATIC DISEASES
Paraquat Toxicity / Parquat Lung TOXICOLOGY
Behcet's Syndrome RHEUMATIC DISEASES
Adrenal Neoplasms ENDOCRINE SYSTEM (red flag)
Enterovirus Infections INFECTIOUS DISEASES
Familial Mediterranean Fever RHEUMATIC DISEASES
Urinary Tract Infection NEPHROLOGY
Crohn Disease GASTROINTESTINAL DISORDERS
Fluke Infection INFECTIOUS DISEASES
Glomerulonephritis NEPHROLOGY
Nephrotic Syndrome NEPHROLOGY
Erythema Multiforme DERMATOLOGY
Hodgkin Disease NEOPLASTIC DISEASES
Neoplasms of the Kidney NEPHROLOGY
Tuberculosis INFECTIOUS DISEASES (red flag)
Aortic Aneurysm / Dissection VASCULAR DISORDERS (red flag)
SLE RHEUMATIC DISEASES (red flag)
Pemphigoid DERMATOLOGY
Common Cold / Nasopharyngitis RESPIRATORY DISORDERS
Heavy Metal Intoxication TOXICOLOGY
Relapsing Fever INFECTIOUS DISEASES
Osteomyelitis and Septic Arthritis INFECTIOUS DISEASES
Ulcerative Colitis GASTROINTESTINAL DISORDERS
Tularemia INFECTIOUS DISEASES
Acute Porphyria METABOLIC DISEASES (red flag)
        


Found pfapa to be the most probable diagnosis








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