A case of XXXX causing @entity409 and @entity3935 .

@entity1 @entity712 @entity3935 @entity738 @entity2379 @entity55 @entity409 @entity8108 @entity281 @entity177 @entity1188 @entity3218 @entity3219 @entity230 @entity99 @entity2059
A 56-year-old @entity1 with persistently elevated liver enzyme levels, fatigue, lethargy and a 9.0 kg weight loss over six months underwent a percutaneous liver biopsy that demonstrated multiple @entity738 . Screening serologies were positive for @entity3219 , and he was started on @entity2059 treatment. He returned to hospital the same night with coffee-ground emesis and in @entity3935 requiring parenteral @entity230 and intensive care unit support. An abdominal computed tomography scan revealed bilaterally enlarged, nonenhancing adrenal glands suggestive of @entity1188 , presumed secondary to @entity3219 . Treatment was initiated with @entity2379 , and @entity3218 was cultured from his urine and cerebrospinal fluid. A serum immunodiffusion test was also positive for both @entity8108 and M bands, indicating @entity281 with @entity3219 species. His serum and urine samples were also weakly positive for the antigen. Despite complications of @entity177 , @entity55 and @entity712 , he recovered with medical therapy and was discharged home to complete a prolonged course of @entity2059 therapy. While @entity99 often reflect an occult disease process, the cause may remain undiscovered in 30% to 50% of @entity1 despite exhaustive investigations. @entity3218 is an uncommon cause of @entity409 , and with its protean clinical presentation, a high index of suspicion is needed to make the diagnosis and avoid the potentially high fatality rate associated with disseminated @entity281 .
