Acta Med Scand 201: 387-389, 1977
Prolonged Monosymptomatic Fever due to Yersinia Enterocolitica Johs. Bliddal and Steen Kaliszan F r o m the Department
of Medicine, Diakonissestiftelsen, Copenhagen, Denmark
ABSTRACT. A previously healthy 14-year-old girl showed monosymptomatic hectic fever for over 3 weeks with negative clinical findings. Extensive laboratory investigation revealed only elevated ESR and a high titer of agglutinating antibodies against Yersinia enterocolitica, serotype 0-3. These abnormalities disappeared upon tetracycline therapy, after which she remained in excellent health. This unusual manifestation of yersiniosis, which was of unknown source, demonstrates that Yersinia infection should be considered in patients with prolonged febrile illnesses of obscure etiology. Human infection with Yersinia enterocolitica, a small gramnegative rod of genus Yersinia, has been recognized as a frequent cause of human disease during the last decade. Commonly observed are acute o r subacute gastroenteritis. mesenteric lymphadenitis, erythema nodosum and arthritis ( 1 . 3, 11, 12, 13, 19). However, quite a variety of other pathological conditions has been associated with yersiniosis. as carditis ( I , I?), acute hepatitis and glomerulonephritis (4, 12). Reiter's disease (17). skin manifestations (8, I I ) , eye inflammations ( 2 ) , meningitis (181, and thyroid disorders ( 5 ) . This paper presents a case of yersiniosis with prolonged monosymptomatic fever of a hectic type as the only clinical manifestation. CASE REPORT A 14-year-old girl with no significant diseases in her past
was admitted to our department due to one week's fever of unknown origin. During that period she had been in Reprint rrqires/ to: J . Bliddal, M.D.. Diakonissestiftelsen. Department of Medicine, P. Bangsvej I , DK-2000 Copenhagen F , Denmark.
bed with normal to slightly elevated temperature in the mornings and fever around 40°C in the evenings. She had had no sore throat, respiratory symptoms, diarrhoea, abdominal pains, arthralgias o r skin eruptions, and clinical examination by her general practitioner disclosed normal findings. There had been n o sickness in her surroundings. It was later revealed that she had been in close contact with a chinchilla 4-5 days before her fever erupted, but neither this animal nor its host family had demonstrated signs of illness at that time. After admission she was kept in bed and her fever persisted as at home, that is a hectic type of temperature curve (Fig. I ) . Apart from slight tiredness and intermittent headache during the periods of elevated temperature, she had no other symptoms whatsoever. H e r clinical appearance was that of a normal healthy girl except for slight flushing of her cheeks related to high temperatures. Physical examination was performed by several doctors. who agreed upon negative findings. ESR SO-60, Hb 12.5 g/lOO ml, BP I2OlXO. normal electrolytes. Urinary sediment, ECG. X-rays of thorax, sinuses and teeth, eye examination and gynaecological exploration revealed nothing abnormal. WBCs were persistently normal. except for slight relative lymphocytosis after two weeks of fever. Ten subsequently cultivated venous blood samples were negative. Extensive laboratory investigation was done to reveal the etiology of her hectic fever. She had normal thrombocytes. liver tests and cold agglutinins. L E cell test. TB test, antinuclear and rheumatoid factors were negative. Electrophoresis of the serum proteins showed slightly elevated cu,-globulins and her immunoglobulins were within normal ranges. Serological testing for leptospirosis. mononucleosis, ornithosis, syphilis. toxopla5rnosis and infection with gonococci, Mycoplasma pneumoniae and haemolytic streptococci was negative. Nothing abnormal was found at Widal's agglutination reactions to Salmonella typhosa. B. abortus Bang. S . typhirnurium and paratyphi B. H-antigen. Paratyphi B. 0-antigen showed I : S O . but this value was unchanged during and after her disease. A consultant in clinical microbiology favoured a viral etiology of her severely fluctuating fever with normal WBCs and good clinical condition. An advocated tetraAi.tii
,W
Prolonged Monosymptomatic Fever due to Yersinia Enterocolitica Johs. Bliddal and Steen Kaliszan F r o m the Department
of Medicine, Diakonissestiftelsen, Copenhagen, Denmark
ABSTRACT. A previously healthy 14-year-old girl showed monosymptomatic hectic fever for over 3 weeks with negative clinical findings. Extensive laboratory investigation revealed only elevated ESR and a high titer of agglutinating antibodies against Yersinia enterocolitica, serotype 0-3. These abnormalities disappeared upon tetracycline therapy, after which she remained in excellent health. This unusual manifestation of yersiniosis, which was of unknown source, demonstrates that Yersinia infection should be considered in patients with prolonged febrile illnesses of obscure etiology. Human infection with Yersinia enterocolitica, a small gramnegative rod of genus Yersinia, has been recognized as a frequent cause of human disease during the last decade. Commonly observed are acute o r subacute gastroenteritis. mesenteric lymphadenitis, erythema nodosum and arthritis ( 1 . 3, 11, 12, 13, 19). However, quite a variety of other pathological conditions has been associated with yersiniosis. as carditis ( I , I?), acute hepatitis and glomerulonephritis (4, 12). Reiter's disease (17). skin manifestations (8, I I ) , eye inflammations ( 2 ) , meningitis (181, and thyroid disorders ( 5 ) . This paper presents a case of yersiniosis with prolonged monosymptomatic fever of a hectic type as the only clinical manifestation. CASE REPORT A 14-year-old girl with no significant diseases in her past
was admitted to our department due to one week's fever of unknown origin. During that period she had been in Reprint rrqires/ to: J . Bliddal, M.D.. Diakonissestiftelsen. Department of Medicine, P. Bangsvej I , DK-2000 Copenhagen F , Denmark.
bed with normal to slightly elevated temperature in the mornings and fever around 40°C in the evenings. She had had no sore throat, respiratory symptoms, diarrhoea, abdominal pains, arthralgias o r skin eruptions, and clinical examination by her general practitioner disclosed normal findings. There had been n o sickness in her surroundings. It was later revealed that she had been in close contact with a chinchilla 4-5 days before her fever erupted, but neither this animal nor its host family had demonstrated signs of illness at that time. After admission she was kept in bed and her fever persisted as at home, that is a hectic type of temperature curve (Fig. I ) . Apart from slight tiredness and intermittent headache during the periods of elevated temperature, she had no other symptoms whatsoever. H e r clinical appearance was that of a normal healthy girl except for slight flushing of her cheeks related to high temperatures. Physical examination was performed by several doctors. who agreed upon negative findings. ESR SO-60, Hb 12.5 g/lOO ml, BP I2OlXO. normal electrolytes. Urinary sediment, ECG. X-rays of thorax, sinuses and teeth, eye examination and gynaecological exploration revealed nothing abnormal. WBCs were persistently normal. except for slight relative lymphocytosis after two weeks of fever. Ten subsequently cultivated venous blood samples were negative. Extensive laboratory investigation was done to reveal the etiology of her hectic fever. She had normal thrombocytes. liver tests and cold agglutinins. L E cell test. TB test, antinuclear and rheumatoid factors were negative. Electrophoresis of the serum proteins showed slightly elevated cu,-globulins and her immunoglobulins were within normal ranges. Serological testing for leptospirosis. mononucleosis, ornithosis, syphilis. toxopla5rnosis and infection with gonococci, Mycoplasma pneumoniae and haemolytic streptococci was negative. Nothing abnormal was found at Widal's agglutination reactions to Salmonella typhosa. B. abortus Bang. S . typhirnurium and paratyphi B. H-antigen. Paratyphi B. 0-antigen showed I : S O . but this value was unchanged during and after her disease. A consultant in clinical microbiology favoured a viral etiology of her severely fluctuating fever with normal WBCs and good clinical condition. An advocated tetraAi.tii
,W
