Fever of unknown origin in an infant with an unexpected blood film report: a case report.

INTRODUCTION Fever of unknown origin (FUO) can be defined as a rectal temperature higher than 38.3 degrees C on several occasions over more than 3 weeks, the diagnosis of which remains uncertain after initial investigations. Identification of the causes and management of FUO in children is an important role of rural primary care physicians, and is guided by thorough history-taking and repeated physical examinations combined with standard laboratory tests and simple imaging procedures. This can be difficult in rural practice due to poor availability and reliability of laboratory and imaging procedures, and the cost and misuse of antibiotics. Dependence on clinical and laboratory examinations may fail in diseases presenting in non-endemic areas. Trypanosomiasis is a known cause of fever; however, it is an unusual cause of FUO considering the place of residence of this patient. CASE REPORT This report describes a case of trypanosomiasis presenting as FUO. The patient was a one-year-old Nigerian female who had been managed for malaria and bronchopneumonia for 2 weeks in a private clinic and was finally referred for further management to Eku Baptist Hospital, a rural mission hospital in the Niger Delta of Nigeria. Results of her laboratory tests showed nothing of significance apart from anaemia and trypanosomes discovered unexpectedly in the blood film. This was confirmed after a cervical lymph node biopsy and microscopic examination of the glandular fluid. Treatment with eflornithine was effective. CONCLUSION The diagnosis of trypanosomiasis in this patient highlights that when a patient is not obviously exposed to the causative factors of a disease, possible occurrences may present a diagnostic problem.