Case records of the Massachusetts General Hospital. Case 26-2007 - a 61-year-old man with recurrent fevers.

Dr. James J. Tolle (Pulmonary and Critical Care Medicine): A 61-year-old man was admitted to this hospital because of recurrent fevers. He had been well until approximately 3.5 months earlier, when chills, fevers, and fatigue developed. He had no cough or production of sputum. He saw his primary care physician, who sent him to the emergency department of another hospital. A chest radiograph revealed a left basilar opacity, and a diagnosis of community-acquired pneumonia was made. A 5-day course of azithromycin was begun. His symptoms persisted, and he was admitted to the same hospital 5 days later. A chest radiograph obtained on admission revealed clear lungs. However, on the third hospital day, a repeated chest radiograph revealed a focal opacity in the posterior right base, and intravenous ceftriaxone and oral doxycycline were begun. Computed tomography (CT) of the chest on the fourth hospital day disclosed an opacity in the right lower lobe, bilateral pleural effusions, and patchy ground-glass opacities in the right upper lobe. A repeated chest CT scan on the 11th day showed resolution of the infiltrates and effusions, but daily fevers to 38.9°C continued. Cultures of blood and urine, thin and thick smears for malaria, and serologic tests for cytomegalovirus and Epstein–Barr virus were negative. A transthoracic echocardiogram was negative for vegetations. A diagnosis of type 2 diabetes mellitus was made, and treatment with insulin was begun. He was transferred to this hospital on the 20th hospital day. At the time of admission, his major symptom was persistent daily fever to 38.9°C; he did not have a cough or sputum production. He had been born and raised in Bangladesh and had immigrated to the United States 4 years earlier; he had last traveled to Bangladesh 9 months before admission and had remained there for 4 months. He was a retired marketing manager. He was married with two children and lived with his family in a suburb of Boston. His wife and children were well. He did not use tobacco, alcohol, or illicit drugs. His medications included ibuprofen as needed, for the fever, and insulin. He had no known drug allergies. The temperature was 36.2°C, and the respirations were 18 breaths per minute. Case 26-2007: A 61-Year-Old Man with Recurrent Fevers