A case of fever of unknown origin?

• DOI: 10.1007/s11739-015-1240-6
• Publication Date: 2015-04-30T11:20:13Z
• Authors: Michela Masotti; Gaetano Bergamaschi; Pietro Formagnana; Gino Roberto Corazza
• Keywords: Male; Prosthesis-Related Infections; Bacteroides Infections; Fever of Unknown Origin; Blood Vessel Prosthesis; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Emergency Medicine; Internal Medicine; Bacteroides; Humans; Tomography, X-Ray Computed; Aged; Aortic Aneurysm, Abdominal

A 74-year-old man was admitted to the Emergency Department (ED) of our Institution for fatigue and fever of 3-week duration. During the last 3 days; 2 days before admission, an empiric antibiotic therapy had been started. The patient had an history of chronic obstructive pulmonary disease, ischemic cardiomyopathy, hemorrhagic stroke, which had caused a cognitive impairment and difficulties in mobilization, HCV-related hepatopathy, obesity, diverticula and an aortic abdominal aneurysm treated with an endoprosthesis 1 year earlier. Two days before admission, he went to the ED of the same Hospital for confusion, and was discharged within a few hours with a diagnosis of progressive cognitive impairment. At the ED, the patient had mild confusion, but the physical examination was otherwise normal. Blood tests showed a mild normocytic anemia. A chest X-ray study was negative for acute lesions. On admission to the Department of Internal Medicine, blood tests showed signs of inflammation and an elevation of procalcitonin. The physical examination showed abdominal tenderness, but there was only mild abdominal pain with no signs of peritonitis. Differential and preliminary diagnosis