Case Study

Ha Noi,19-Sep-2022
I- Medical history
• Boy, 15 years old.
• Hospitalized because: Dyspnea with fever and cough
• 15/07/2022. Biopsy at VNCH. Pathology: Midline thymic
undifferentiated carcinoma.
• LCA-; CD20-; CD3+; CD79a-; CD30-; CD15-
• ALK-; Ki67+; CKAE1/3+; CK7+
• 16/08/2022, Complete tumour removal sugery at VietDuc Hospital.
• 07/09/2022, He had dyspnea  transfer to K Hospital
Status at the time of hospitalization:
• Da xanh niêm mạc nhợt
• Thể trạng gầy, ăn uống kém
• Sốt cao liên tục 38.5-39 độ C cách 7 ngày
• Ho, khó thở, phổi thông được 2 bên
Examination (09-Sep-2022)
• Hb= 118G/L
• Wbc= 17.91G/L
• Plt= 485G/L
• AST/ALT =33/35
• Creatinin= 59 mcmol/L
• CRP hs= 131.23 mg/dl
• COVID-19 : Positive.
 Treament : antibiotic and follow up (waiting Pathology result).
CT-scan (11-July-2022)

• http://benhviendakhoanongnghiep.vn:89/Viewer/s#/view?id=8b366447-fc87-4a5f-897f-0a9e28a440fe
X-ray (17-Sep-2022)
Examination (19-Sep-2022)
• Hb=117 G/L
• Wbc=21.3 G/L
• Plt=569 G/L
• AST/ALT =33/35
• Creatinin= 59 mcmol/L
• CRP hs= 10.2 mg/dl
• COVID-19 : Negative.
• Ddimer = 1127ng/ml
• PCT: 1h=50mm.2h=70mm
Summary:
• Boy, 15 years old.
• Diagnosis: Thymic carcinoma
• Pathology: Lymphoepithelioma – like carcinoma
• Negative: CD5,CD117,P63,SALL4,PAX8.
• Positive: CKAE1/AE3.

• Treatment: antibiotic .
• Currently: He has a high fever continuously despite 2 antibiotics.
severe fatigue, shortness of breath even though no need for oxygen
therapy.
Question:
• This is a very rare case we have never seen before. The patient has
continuous fever, with low CRP despite 2 antibiotics treatment. What
can we do for him?

Thank You!