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Hepatitis B Patient with FeverDue to Focal Infection
Ria Aryani Hayuningtyas0906508945
Journal of International Medicine Association Bulgaria2012, vol
18, book 4
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50 y.o woman
Chronic Hepatitis BFebrileSeptic Fever
Consultations:EndocrinologistRheumatologistNeurologist
DynecologistPulmologistInfectionstSerology
NEGATIVECorticosteroid
Treatments:Gentamycin Amoxicillin
AzithromycinCiprofloxacinMethronidazoleMeronemClindamicinNystatin
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DentalDiagnosis
17, 16, 27, 43, 47 potential dental fociSubmandibular lymph
nodes
Afebrile 5 daysafterwards
Dental fociEXTRACTED
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INTRODUICTION
Fever of unknown origin (FUO) defined asa temperature > 38.3
C that last for morethan 3 weeks with no obvious source
andevaluation of at least 3 visit or 3 days inhospital
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Common etiologies for FOU
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CASE DETAIL
50 years old Woman : Febrile for past 2 months
Septic fever Moderate pain & weakness in 4 limbs Diagnosed
with chronic hepatitis B, 2
weeks after the fever onset
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CASE DETAIL
Examination : HBV-DNA 533.000.000 copies/ml Normal blood count
& hemoglobin Normal bilirubine & INR No autoimmune disease
Progressive hypoalbuminemia Elevated CRP & prominenet liver
necrosis
with ALT predomination No liver compensation
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50 y.o woman
Chronic Hepatitis BFebrileSeptic Fever
Consultations:EndocrinologistRheumatologistNeurologist
DynecologistPulmologistInfectionstSerology
NEGATIVECorticosteroid
Treatments:Gentamycin Amoxicillin
AzithromycinCiprofloxacinMethronidazoleMeronemClindamicinNystatin
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Dental di agnostic : Clinical examination dental status,
palpation of lymph nodes, percussion X-ray diagnostic Gelen test
detection of active dental foci
Thermovision
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RESULT
Swollen lymph nodes Gelen test no active dental foci but 17,
16, 27, 43, 47 potential dental foci
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16 periapical& periodontal
changes
17 Non vital,periapical &periodontal
changes
27 periapical
& periodontalchanges
47 Non vital,periapical &periodontal
changes
43 periapical& periodontal
changes
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Active temperature zone submandibular nodes
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Extraction17, 16, 27, 43, 47
Afebrile 5 days afterwardsCRP & Albumin returned normal
LamivudineHBV antiviral therapy
DENTAL RECOMMENDATION
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DISCUSSION
Oral infections have a disastrous effects onsystemic health Most
patients with FUO have no dental
symptoms oral cavity is overlooked Antibiotic therapy can be
made before,
during and after dental procedures Dental foci routes:
1. Blood circulation2. Lymphatic distribution locally blood3.
Retrograde axonal transport
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CONCLUSION
Oral symptoms usually not present in FUO oral cavity is
overlooked during
physical examination
