Case Challenge #1 – ID Mimics

Introducing the UT Southwestern Internal Medicine Case Challenges! For the next 10 weeks, we will be posting a series of cases, each related to the fever of unknown origin post. The answer will be posted on Friday morning, but you can send in your thoughts in the comments section. Good luck! (content is from Dr. Brad Cutrell and inspired by Dr. Bennett Lorber at IDBR course).

Case Challenge # 1

  • 32 yo male with recent diagnosis of AML s/p induction chemotherapy who presents with new fever and rash. Patient has been receiving G-CSF and marrow recovered with WBC of 15k with 35% bands. She has no localizing symptoms, but blood Cx sent and started on broad spectrum antibiotics.
  • PE: Tmax 102.3, multiple red papulonodular lesions on face, neck and extremities. Tender, non-pruritic. Evolve into central yellowish discoloration. Skin biopsy shows dense neutrophilic infiltrates without vasculitis and negative infectious stains.
  • Fever and lesions persist despite abx and Cx are negative.

FUO case 1

  • What is most likely diagnosis?

  • A) Pyoderma gangrenosum
  • B) Sweet Syndrome
  • C) Drug reaction from G-CSF
  • D) Disseminated fungal infection
  • E) Staphylococcal furunculosis

The answer will be posted Friday, January 30th, 2015!

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