Serological testing was performed for leptospira, rickettsiae, Epstein Barr virus, cytomegalovirus, toxoplasmosis, HIV and hantavirus, as well as antistreptolysin O titre and meningococcal PCR. local wildlife. Consequently, the authors urge physicians to be alert to this probability when faced with acute renal failure in association with an undiagnosed febrile illness, particularly when there is a history of an appropriate environmental or animal exposure. Background This disease is likely to be seen increasingly in the UK as an imported infection due to patterns of travel and immigration, and in addition, as little is known about its endemnicity in the UK, illness Sigma-1 receptor antagonist 2 could be acquired here in people with occupational or recreational exposure, therefore, we wish to increase awareness of the syndrome in order to Sigma-1 receptor antagonist 2 improve analysis and patient management. Case demonstration A 35-year-old Caucasian man presented to accident and emergency in January 2010 having a 4 day time history of headache, backache, fever and myalgia. His symptoms were present on waking the morning after he had eaten at a Chinese restaurant. Initially headache predominated, which progressed to lumbar backache over 24 h. He had intermittent slight blurring of vision, but no orbital pain, and no additional neurological symptoms, neck stiffness or photophobia. He developed fever and generalised myalgia, but no focal joint pain or swelling. He vomited once but experienced no additional gastrointestinal upset. He also noticed dark urine, but refused frank haematuria, dysuria, frequency or oliguria. There were no respiratory symptoms, coryza or rash. The patient experienced no previous medical history, was taking paracetamol and ibuprofen as required for his current illness, and experienced no allergies. He was married with one child, consumed Rabbit polyclonal to ISCU 15C20 devices of alcohol per week and did not smoke or take illicit medicines. He worked well for London underground developing security systems but he had not been in a station for many months. On exam, his temp was 38.2C, heart rate 110 beats per min and blood pressure 116/80. Oxygen saturations were 97% on space air with no respiratory distress. There were no indications of meningism, rash, lymphadenopathy or jaundice. He had dry mucous membranes, periorbital oedema, conjunctival suffusion and some right top quadrant tenderness, but no organomegaly. He was mildly tender on the lumbar spine. Cardiorespiratory, neurological and ear, nose and throat examinations were unremarkable. Investigations Results of initial investigations were as follows: haemoglobin 19.6 g/dl, packed cell volume 0.57, white cell count 17.2109/l (neutrophils 13.9, lymphocytes 2.9), platelets 80109/l, urea 14.1 mmol/l, creatinine 150 umol/l, albumin 32 g/l, sodium, potassium, bilirubin and transaminases levels were normal, C-reactive protein 90 mg/l and coagulation was normal. Urinalysis revealed protein ++ and blood ++. Chest radiograph was normal. Further investigations (included in end result and follow-up): ultrasound of renal tracts was normal. Blood, throat and urine cultures were negative, and nasopharyngeal swab for respiratory viruses was also bad. Blood film showed large reactive lymphocytes, low platelets, but no haemolysis. Serological screening was performed for leptospira, rickettsiae, Epstein Barr disease, cytomegalovirus, toxoplasmosis, HIV and hantavirus, as well as antistreptolysin O titre and meningococcal PCR. Antinuclear antibody, antineutrophil cytoplasmic antibody, immunoglobulins and match screening were also requested. All were bad. Sigma-1 receptor antagonist 2 Treatment The patient was admitted to a medical ward for intravenous fluids and monitoring of fluid balance and renal function. Blood, throat swab and urine were sent for tradition and he was commenced on co-amoxiclav 1. 2 g three times each day and doxycycline 100 mg twice daily. End result and follow-up On day time 2, the individuals headache was resolving but lower back pain persisted. His fever also settled. Sigma-1 receptor antagonist 2 His urine output was not accurately recorded, but appeared adequate. However, his creatinine increased to 332 umol/l and platelets fallen to 50109/l on day time 3 (number 1). Open in a separate window Number 1 Creatinine and platelet count through the course of the illness. On more detailed questioning, he had travelled to Estonia, to spend Christmas and New Yr with his wifes family, and returned Sigma-1 receptor antagonist 2 to the UK 3 weeks before becoming unwell. He stayed inside a rural, forested area, where he spent a lot of time outdoors sledging,.