The clinical scenario goes with histoplasmosis 

Abbas Mohammad

These symptomes caused by chlamydophila infections. And tretment by tetracycline for 14 to21 days


Dr Hala

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Dr. Fatemeh Kourkinejad

What's your diagnosis?

A 5 year old girl with fever and Epigasteric pain and coriza and productive cough, nausea and anorexia from 2 days earlier refered to emergency department. 
History of contacts with cats and pigeons. No contacts with dogs or other domestic animals. No history of eating  raw meat or unsterilized milk and dairy products. No history of TB in family.
PR 135 febrile T 38.5
RR35 o2sat98% . Hepatomegaly and red macular lesions on palms and soles. chest ct scan was NL.  Sonography showed in bellow picture. Positive findings : hepatomegaly, hypoecho region with well defined border without vascularity in subdiaghragmic region in perihepatic area. Diameter10mm. 
Gall bladder with increased wall thickness and edema. Spleen span 88mm. 
Kidneys NL. No sign of appendicitis target.

Please help me with diagnosis. What is the ddx?
Thanks

What's your diagnosis?

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