TABLE I

TABLE I

Clinical and Investigative Profile of the Case.

No of Admission	Month/year of admission	Duration of fever	Principal clinical findings	Investigations		Treatment
No of Admission	Month/year of admission	Duration of fever	Principal clinical findings	Positive	Negative	Treatment
1.	Feb’95	30 days	High grade fever, Hepatosplenomegaly	Positive Mantoux Doubtful hilar lymphadenopathy	Blood counts, Widal, Cultures, peripheral smear, LET	ATT (EHRZ × 2 months +HR × 4 months)
2.	Oct’96	15 days	- do - Pallor additionally	Non-caseating granulomas in liver biopsy	Bone marrow aspiration, ANA Rheumatoid factor, splenic puncture, ELISA and Aldehyde tests for Kala Azar, HIV	ATT (SHRZ × 2 months +HR × 10 months)
3.	Jul’97	20 days	-do-	Nil		Empirical antimalarials, antibiotics
4.	Sep’98	15 days	-do-	Nil	CSF studies, ELISA for Tuberculosis, Immunoglobulin profile	pontaneous defervescence
5.	Sep’99	90 days	Pogressive pallor and petechiae. Generalized seizures and coma for 2 weeks following a cardiac arrest during artemether treatment	Non caseating granulomas in bone marrow-AFB and fungus-negative Pancytopenia with reticulocytosis. CT scan abdomen-retroperitoneal lymphadenopathy.	FNAC axillary lymph node, CSF and bone marrow PCR for tuberculosis, DsDNA, Brucella (2ME), TORCH titers, Serum Calcium, Serum LDH, Splenic biopsy, Angiotensin Converting Enzyme (ACE).	Antimalarials Splenectomy ATT (SHRZE+ Ofloxacin × 2 months, HR + Oflaoxacin × 10 months)
6.	Jul’01	90 days	Abscess nose, massive hepatomegaly, dysuria, external hemorrhoids	pancytopenia Serum bilirubin 7 mg/dL (Direct Postive) Serum Alk Phosphatase 3290 IU/L SGPT 233 U/L Gamma GT 556 IU/L Serum Cholesterol 475 mg/dL Liver biopsy-non caseating granulomas Bone marrow-non-caseating granulomas Urine culture-Candida	Platelet counts, DCT, prothrombin time, USG abdomen KUB, CT chest and abdomen, DTPA scan, viral markers for hepatitis, CD4/CD8 counts, 2D Echo, ANCA, Anti Sm antibody, Anti LKM, antibody, Colonoscopy, Barium enema.	Amphotericin for urinary infection. Prednisolone (60mg/day) tapered to 10 mg/ alternate day) Methotrexate 7.5 mg per week

LFT-Liver function test, ANA-Anti nuclear antibody, FNAC-Fine needle aspiration cytology, PCR-Polymerase chain reaction, DsDNA-Anti Double 
stranded DNA antibody, HIV-Antibody to Human immunodeficiency virus, 2ME-2 Mercapto ethanol, LDH-Lactate dehydrogenase, DCT-Direct
Coomb’s test, USG KUB-Ultrasound scan KUB area, ANCA-Anti neutrophil cytoplasmic antibody, LKM-Anti liver kidney, mitochondrial antibody, 
AFB-Acid fast bacillus, ATT-Antibubercular therapy, DTPA-Diethyl triamine penta acetic acid scan, CSF-Cerebrospinal fluid.