We appreciate the comments made by Drs Espinoza and Espinoza, who detected a normal ESR in an elderly patient with temporal arteritis and persistent fever. Their letter underscores the limitations of a review article that formulates general principles. These physicians are to be congratulated on exercising clinical judgment and not relying exclusively on laboratory tests to establish the appropriate diagnosis.
We would also like to mention another cause of persistent unexplained fever, namely, occult dental sepsis.1 This treatable disorder was inadvertently omitted in our review.
Esposito A, Gleckman R. Temporal Arteritis With Normal ESR-Reply. Arch Intern Med. 1980;140(2):282. doi:10.1001/archinte.1980.00330140140042