[Fever and right upper abdominal pain in a 26-year-old returning from travel abroad]. / Fieber und rechtsseitige Oberbauchschmerzen bei einem 26-jährigen Reiserückkehrer.

Persistent fever and unspecific general symptoms need a complete and detailed medical history and search for infection. We report on a case of amebiasis with liver abscesses of a 26-year-old man. He had stayed several weeks in India and South America. After being free of complaints for 4 months, unspecific general symptoms and fever appeared. Due to proven liver abscesses, a combination treatment was given. Within 12 days, he was free of symptoms and could be discharged.

[Fever, leg swelling, coughing, and left upper quadrant pain in a 19-year-old woman]. / Fieber, Unterschenkelschwellung, Husten und linksseitige Oberbauchschmerzen bei einer 19-jährigen Patientin.

Persistent fever and unspecific general symptoms need a complete and thorough medical history and search for infection. We report on a case of brucellosis (Malta fever) with involvement of organs in a 19-year-old woman. She had previously lived on a farm in Portugal for several weeks, where she had consumed self-produced goat cheese. After a latency period of several months, unspecific general symptoms, fever, monarthritis, an increase of transaminases, and a newly diagnosed cardiac murmur became apparent. After the serologic and cultural proof of brucellosis, the patient underwent an antibiotic combination therapy. Within 20 days she was free of symptoms and could be released.

[Fever and renal failure in a 38-year-old woman]. / Fieber und Nierenversagen bei einer 38-jährigen Patientin.

Persistent fever and sepsis require a thorough anamnesis and examination especially in women of childbearing age to determine the presence of implanted devices. We report on a case of a severe septic shock with renal failure in a 38-year-old woman triggered by an infected intrauterine device (IUD). After a symptom-free period of 4 weeks after implantation of the pessary, acute and rapidly progressive nonspecific general symptoms and fever occurred. Vaginal smears detect Staphylococcus (S.) aureus. After removal of the pessary under broad antibiotic therapy and short-term continuous veno-venous hemofiltration in combination with CytoSorb®, the patient was quickly stabilized. Within 8 days she was free of symptoms and could be transferred to a normal ward. It should be specifically noted that after receipt of the antibiogram, there was no change of treatment to flucloxacillin, which would have been more sensitive for S. Aureus.

Influence of recombinant human erythropoietin on hematological and hemostatic parameters with special reference to microhemolysis.

Twenty chronic hemodialysis patients with renal anemia (hematocrit < 25%) received recombinant human erythropoietin (40 IU/kg body weight 3 x weekly) intravenously after each dialysis. Prior to and at 4, 8 and 12 weeks after commencement of erythropoietin therapy, hematocrit together with hemostasis and microhemolysis parameters were determined. There were significant increases in hematocrit, platelet count and platelet retention, but a significant fall in the initial clearly prolonged bleeding time. Free plasma hemoglobin likewise increased. Conversely, lactate dehydrogenase, prothrombin time, fibrinogen, antithrombin III activity, protein C activity and protein S concentration were all unaltered. The positive effect on bleeding time and platelet retention is most probably caused by an increase in adenosine diphosphate due to the hematocrit-dependent rise in the blood shear stress via physiologic microhemolysis (raised free plasma hemoglobin).