HEPATITIS B PATIENT WITH FEVER DUE TO FOCAL INFECTION

Abstract

Persistent undiagnosed fever remains a common problem in clinical practice. It is a fact that dental sepsis is one potential cause of persistent fever that can escape detection (Siminoski, K., 1993). We present a 50 years old woman with chronic hepatitis B, febrile for the past two months (max. 38.60C) with characteristic of septic fever. She underwent consultations with endocrinologist, rheumatologist, neurologist, gynecologist, pulmonologist and infectionst. All negative for any disease, also negative serology for Lyme disease. She had no data for urine infection. She had negative cultures. The patient was treated with corticosteroids for 30 days with no effect; she had no response to treatment with Gentamycin, Amoxicillin, Azithromycin, Ciprofloxacin, Methronidazole, Meronem, Clindamicin and Nystatin. Only reduction but not normalization, of CRP was observed, the fever remained. The patient underwent focal dental diagnostic protocol. We remarked potential dental foci - 17, 16, 27, 43, 47 and active temperature zone – submandibular lymph nodes. The dental focuses were extracted consequently and the patient became afebrile 5 days afterwards. Her liver enzymes, CRP and albumin returned to normal after performance of dental recommendations.

Keywords

• fever
• focal infection
• dental sepsis