A 41-year-old man presented to the emergency department complaining of weakness, fevers and night sweats for the past several months. He described a 6-month history of progressive generalized weakness, noting that, during the past 3 months, he had developed nonproductive cough and frequent drenching night sweats. The severity of his weakness confined him to his home in the 2 months before presentation.The patient's medical history was significant for hepatitis C and was treated successfully with pegylated interferon-alpha 3 years before. In addition, he had experienced constipation during the past 1 year and had undergone a Lord anal dilatation procedure because of severity of the complaint. At the time of the operation, approximately 6 months before his presentation, he had been told that his blood counts were "low." The patient's medications were Senna and a multivitamin. He smoked 1 pack of cigarettes monthly and imbibed mixed drinks twice weekly. Because of severe fatigue during the past year, he used occasional oral methamphetamines. He had never used intravenous drugs. The patient is homosexual and stated that he usually used condoms. His last sexual contact was 2 years before presentation. At the time of hepatitis C treatment, he was human immunodeficiency virus (HTV) negative per his report. Family history was noncontributory. Review of systems was additionally positive for a 10-pound weight loss, poor appetite, early satiety, depressive symptoms, easy bruising and diffuse myalgias. The patient was dyspneic on exertion. There was no history of hemoptysis. There was no orthopnea, paroxysmal nocturnal dyspnea, chest pain or palpitations.
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