Abstract
Presenting features
A 47-year-old Taiwanese man with no notable medical history was admitted with low-grade
fevers and night sweats that had persisted for 5 to 6 weeks. An extensive investigation
at another hospital could not determine the cause of the fevers, but documented acute
renal failure with a blood urea nitrogen level of 60 mg/dL and a serum creatinine
level of 5.6 mg/dL. He was admitted to the Johns Hopkins Hospital for further evaluation.
The patient, who had been living in the United States for the past 20 years, reported
no recent travel and no behaviors that are associated with transmission of human immunodeficiency
virus. He was not taking any medications, and he denied using herbal or nutritional
supplements. He had no recent weight loss. There were no specific complaints on review
of systems.
On physical examination, he was a thin, middle-aged man in no distress. Vital signs
included a temperature of 37.5°C, a blood pressure of 166/86 mm Hg, a pulse of 70
beats per minute, a respiratory rate of 16 breaths per minute, and 99% oxygen saturation
on room air. Sclera were anicteric, and he had no palpable adenopathy. His lungs were
clear, and his heart rate was regular without extra sounds. His abdomen was thin,
nontender, and without masses or organomegaly. There was no edema or signs of embolism
in the extremities.
Laboratory studies revealed a white blood cell count of 14,200/mL3, a hematocrit of 23.1%, and a platelet count of 456,000/mL3. Blood chemistries were notable for a blood urea nitrogen level of 61 mg/dL and a
serum creatinine level of 7.6 mg/dL. Levels of aminotransferases, total bilirubin,
and alkaline phosphatase were within normal limits. Urinalysis revealed large hemoglobin,
1+ protein, numerous red blood cells, and 3 to 5 white blood cells. Numerous red blood
cell casts were seen on microscopic examination of the urine sediment. The patient’s
erythrocyte sedimentation rate was >130 mm/h, and his C-reactive protein level was
elevated at 12.6 mg/dL. Serologies were negative for antinuclear antibodies and antineutrophil
cytoplasmic antibodies; serum complement levels were normal.
What is the diagnosis?
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References
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Article info
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Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
