Fever of unknown origin - Trip Gulick, MD/ Susan Dorman, MD

Update: 2024-06-03

Description

A 40-year-old female is admitted with a 3-week history of daily fever accompanied by a non-pruritic skin

eruption. She was initially seen at a walk-in clinic 5 weeks ago for cough and given a 7-day course of

Augmentin for bronchitis with resolution of respiratory symptoms. In the last 2 weeks she has developed

diffuse arthritis of hands, knees, elbows, and ankles.

Labs include WBC of 7.8 (82% seg, 15% lymph, 3% eos), platelets of 159, alkaline phosphatase of 454, ALT/AST

137/118 and bilirubin 1.9.

CRP is 183.6, rheumatoid factor <10, ANA negative. Ferritin is 8622

CT scan of the abdomen shows hepatosplenomegaly and peri-portal lymphadenopathy.

What is the most likely diagnosis for this patient?

A. Adult-onset Still’s disease

B. DRESS (drug associated rash with eosinophilia and systemic symptoms)

C. SLE (systemic lupus erythematosus)

D. HLH (hemophagocytic lymphohistiocytosis)

E. Acute CMV infection

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Fever of unknown origin - Trip Gulick, MD/ Susan Dorman, MD

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#box-pro-ellipsis-176410814608620{-webkit-line-clamp:2;}Fever of unknown origin - Trip Gulick, MD/ Susan Dorman, MD

Fever of unknown origin - Trip Gulick, MD/ Susan Dorman, MD

John Bennett, MD / Henry Masur, MD

Fever of unknown origin - Trip Gulick, MD/ Susan Dorman, MD