A 78-year-old male with a 4-month history of Fever, fatigue, and weight loss.

摘要

A 78-year-old male presented for evaluation of a cold, painful left foot. He had undergone two recent hospital admissions for unexplained fever, fatigue, arthralgias, and an 8- to 10-lb. weight loss over a 4-month period. The patient had a past medical history of hypertension, hyperlipidemia, benign colon polyps, type II mixed cryoglobulinemia, and a bioprosthetic aortic valve that was placed 2 years earlier. Despite extensive evaluations during these two admissions, including three trans-esophageal echocardiograms that demonstrated a normally functioning aortic bioprosthesis, no diagnosis was established. Type II mixed cryoglobulinemia was documented and treated with oral steroids and brief plasmapheresis.