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JAMA Surgery Clinical Challenge
May 2014

Man With Nausea and Fever

Author Affiliations
  • 1Department of Internal Medicine, University Hospitals, Cleveland, Ohio
  • 2Department of Surgery, University of Wisconsin, Madison
JAMA Surg. 2014;149(5):487-488. doi:10.1001/jamasurg.2013.1381

A 52-year-old man presented with a 2-day history of nausea and low-grade fever to a local hospital. He had a history of simultaneous pancreas-kidney transplantation 15 years ago and both grafts had been functioning well. Two days prior to presentation, he had a peripheral angiogram done to evaluate a nonhealing left foot ulcer by an interventional cardiologist, at which time a stent graft was deployed to the right common iliac artery for a pseudoaneurysm that was incidentally discovered. On examination, he was in no distress, had a temperature of 37° C, and blood pressure of 91/44 mm Hg. Two days after presentation, a computed tomographic scan of the abdomen and pelvis was obtained (Figure). It showed an air-containing abscess and a stent in the common iliac artery.

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