Posters

Discipline Track

Clinical Science

Abstract

A 51-year-old Hispanic male with Type 2 diabetes mellitus and dyslipidemia was admitted from the ED for evaluation of recurrent fevers, multiple joint pains, and tachycardia. Physical exam findings included cachectic appearance and right inguinal lymphadenopathy. Initial laboratory testing was significant for a WBC of 23,300 (80.2% neutrophils, 13.3% lymphocytes), Hb of 11.1, HCT of 33.1, and ESR of 120. Chest x-ray reported no acute findings and x-ray imaging of affected joints were unremarkable. Blood and urine cultures would eventually return negative. Despite acetaminophen and broad-spectrum antibiotic use, the patient continued with fevers and tachycardia, prompting further infectious and rheumatological work-up. The following all returned negative: HIV, hepatitis, QuantiFERON-Gold, CCP, dsDNA, RF, ANA, COVID-19, typhus IgM/IgG. On hospital day 5, the patient became hypoxic on room air requiring supplemental oxygen. Repeat chest x-ray reported diffuse infiltrates, and CT imaging of the chest reported bilateral ground glass opacities, multifocal pneumonia, and moderate bilateral pleural effusions. Additional testing was negative for repeat COVID-19, two sets of AFB cultures, and for antibodies for Histoplasma, Aspergillus, Brucella, Dengue, Chikungunya, Coccidioides, and Toxoplasma. Monospot testing was positive with negative EBV IgG/IgM and CMV IgM. Only CMV IgG returned positive, nine-fold above the upper limit. The patient would eventually undergo both inguinal and pelvic lymph node biopsies ruling out malignancy during his hospital stay before resolution of fever, tachycardia, and pulmonary symptoms.

Presentation Type

Poster

Academic Level

Resident

Mentor/PI Department

Family Medicine

Share

COinS
 

CMV? An Uncommon Etiology For Significant Disease In The Immunocompetent Individual

A 51-year-old Hispanic male with Type 2 diabetes mellitus and dyslipidemia was admitted from the ED for evaluation of recurrent fevers, multiple joint pains, and tachycardia. Physical exam findings included cachectic appearance and right inguinal lymphadenopathy. Initial laboratory testing was significant for a WBC of 23,300 (80.2% neutrophils, 13.3% lymphocytes), Hb of 11.1, HCT of 33.1, and ESR of 120. Chest x-ray reported no acute findings and x-ray imaging of affected joints were unremarkable. Blood and urine cultures would eventually return negative. Despite acetaminophen and broad-spectrum antibiotic use, the patient continued with fevers and tachycardia, prompting further infectious and rheumatological work-up. The following all returned negative: HIV, hepatitis, QuantiFERON-Gold, CCP, dsDNA, RF, ANA, COVID-19, typhus IgM/IgG. On hospital day 5, the patient became hypoxic on room air requiring supplemental oxygen. Repeat chest x-ray reported diffuse infiltrates, and CT imaging of the chest reported bilateral ground glass opacities, multifocal pneumonia, and moderate bilateral pleural effusions. Additional testing was negative for repeat COVID-19, two sets of AFB cultures, and for antibodies for Histoplasma, Aspergillus, Brucella, Dengue, Chikungunya, Coccidioides, and Toxoplasma. Monospot testing was positive with negative EBV IgG/IgM and CMV IgM. Only CMV IgG returned positive, nine-fold above the upper limit. The patient would eventually undergo both inguinal and pelvic lymph node biopsies ruling out malignancy during his hospital stay before resolution of fever, tachycardia, and pulmonary symptoms.

 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.