A 73-year-old-man with fever and weight loss.

摘要

A 73-year-old-man was admitted to the hospital for progressive episodes of fever and weight loss. The patient was well until 2 months before admission when he went hunting on a deer lease. He had attended animals (mainly goats and dogs) on the lease, and this amount of work made him quite exhausted. He denied animal or tick bites. He sought no medical attention at the time but experienced subjective fever and chills intermittently. He also reported poor appetite and ongoing night sweats requiring wardrobe changes. One month before admission, he saw his dentist for dental caries and completed a course of antibiotics. Although his tooth pain improved, he developed diffuse arthralgias and myalgias. On the day of admission, he saw his primary care physician for the progressive symptoms. By this time, he noted a 25-pound weight loss. However, he denied chest pain, shortness of breath, hematuria, ecchymoses, and change in the bowel or urinary habits.