A 21-Year-Old Woman With Persistent Fever and Malaise

Muralikrishna Gopalakrishnamoorthy, MBBS, PGY-1; Archana Bhaskaran, MBBS, PGY-1; Rajeswari Anaparthy, MBBS, PGY-1; Ted T. Lin, MS3; Syed Hasan, MBBS


September 30, 2015

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.


A 21-year-old woman presents to the emergency department with a 1-month history of fever; general malaise; and mild, diffuse cramping and abdominal pain. The abdominal pain is generalized, with no specific aggravating or relieving factors, and it is not associated with constipation or diarrhea. She also reports a productive cough, with occasional blood-tinged sputum.

Figure 1.

Upon further questioning, she states that she has been experiencing night sweats, has subjectively lost weight over the past month, and is becoming progressively more short of breath with mild exertion. The patient denies having sore throat, wheezing, pleuritic chest pain, or rash, as well as lower-extremity swelling or paroxysmal nocturnal dyspnea. She also denies any recent travel, has not been incarcerated or stayed in any shelters, and has not had any known tuberculosis exposures. She does not have any pets. She is a nonsmoker and denies using intravenous drugs.

The patient has a medical history of asthma and was recently diagnosed with HIV/AIDS, for which she is currently not on antiretroviral medications. Her current medications include albuterol, fluticasone, and occasional ibuprofen. She received her annual influenza vaccine 1 month ago. She denies a history of allergy to medications.


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