If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
A 58-year-old man presented to the Johns Hopkins Hospital complaining of a 9-month
history of malaise, fevers, night sweats, and weight loss. His fevers were episodic
in nature with periods of constant fevers reaching high peaks (104°F) during the day
from 5 to 7 days followed by an afebrile period 3 to 4 weeks. A typical fever curve
of these episodes is shown in Figure 1 Note that the patient’s temperature rarely drops below the febrile range, <38°C.
Review of symptoms was noteworthy for the lack of headache, pharyngitis, sinus congestion,
cough, abdominal pain, diarrhea, arthritis, rashes, dysuria, urinary frequency, or
neurologic symptoms. He had been placed on numerous courses of antibiotics, including
levofloxacin and clarithromycin, during the months before ad-mission without a change
in his symp-toms. Past medical history was unremarkable. He was on no medications.
He denied recent travel, exposure to farm or exotic animals, or illicit drug use.
He had been monogamous with his wife.
His admission physical examination was notable for a temperature of 104.4°F and firm
enlarged (1.5 to 2 cm) cervical and axillary lymph nodes. Admission laboratory data
were notable for elevated liver function enzyme (aspartate aminotransferase 50, alanine
aminotransferase 73, alanine phosphatase 274), and pancytopenia with a white blood
cell count of 1300/mm3 (but a normal white cell differential), hematocrit level of 26, and platelet count
of 103.000/mm3. To elucidate the etiology of his febrile episodes, a diagnostic procedure was performed.
What is the diagnosis?
To read this article in full you will need to make a payment