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Article
November 1986

Persistent Fever in an Immunocompromised Host

Author Affiliations

From the Department of Medicine, Section of Cardiology, Cardiology Graphics Laboratory, Northwestern University Medical School, Chicago.

Arch Intern Med. 1986;146(11):2253-2255. doi:10.1001/archinte.1986.00360230195028
Abstract

A 36-year-old woman receiving long-term steroid therapy for lupus nephritis was admitted to Northwestern Memorial Hospital, Chicago, for the evaluation of a persistent fever. Three months before admission to the hospital, the patient developed progressive renal failure requiring hemodialysis. Her hospital course was complicated by the development of a catheter-induced enterococcal bacteremia, requiring parenteral broad-spectrum antibiotics. An arteriovenous fistula was created for long-term hemodialysis. One week before admission to the hospital, she again developed a fever and had a temperature of 38.8°C with diarrhea and headaches. Blood samples for cultures were drawn during dialysis. At the time of hospital admission, her vital signs were as follows: blood pressure, 90/50 mm Hg; pulse rate, 97 beats per minute; and temperature, 37.5°C. Splinter hemorrhages were present on her fingers. On cardiac examination, the S, was diminished and the S2 was normal. A grade 3/6 holosystolic murmur was heard best at the

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