Endgames Case report

Recurrent fever after a holiday in Turkey

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d7832 (Published 16 December 2011) Cite this as: BMJ 2011;343:d7832
  1. Adrian Egli, resident 1,
  2. Nina Khanna, senior consultant 1,
  3. Thomas Schmid, resident 2,
  4. Sonja Rudin, technician3,
  5. Reno Frei, head of division 3,
  6. Annette Blaich, consultant 3
  1. 1Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, CH-4031 Basel, Switzerland
  2. 2Department of Internal Medicine, University Hospital Basel
  3. 3Division of Clinical Microbiology, University Hospital Basel
  1. Correspondence to: A Blaich blaicha{at}uhbs.ch

In early October 2010, a 64 year old man presented to our hospital with chest pain, fever, and night sweats, which had been present since his return to Switzerland three weeks earlier. He had been on holiday in Turkey from July to mid-September. On further questioning he reported an episode of diarrhoea and sickness associated with fever shortly after returning home to Switzerland. During his stay in Turkey he had eaten fresh food, including meat and dairy products. Furthermore, he had experienced a myocardial infarction and had undergone angiography and insertion of a bare metal stent on 4 September while in Turkey.

Previously he had been treated with a calcium channel blocker and an angiotensin II receptor antagonist because of high blood pressure. On admission, aspartate aminotransferase at 79 U/L (reference range 11-36), alanine aminotransferase at 86 U/L (10-37), γ glutamyltransferase at 192 U/L (11-66), alkaline phosphatase at 238 U/L (0-129), and C reactive protein (CRP) at 25.4 mg/L (0-10) were all slightly raised. Stenosis of the right coronary artery was seen on angiography and another stent was inserted. Over the next seven days he developed recurrent fevers, which were accompanied by chills and temperatures as high as 39.5°C. Ten of 13 aerobic blood cultures taken at three to 10 days after presentation grew very small Gram negative rods two and a half to three days after incubation. Bloods taken during this time showed a normal white cell count and slightly decreased haemoglobin of 130 g/L (140-180). An abdominal ultrasound showed an enlarged spleen and mild hepatosteatosis. Computed tomography of the chest and abdomen and transoesophageal echocardiography were performed to look for a source of infection, but all were uninformative.


  • 1 What bacterial infection do you suspect?

  • 2 What further tests might help to confirm the suspected diagnosis?

  • 3 How …

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