Case 26-2018: A 48-Year-Old Man with Fever, Chills, Myalgias, and Rash

At the other hospital, examination revealed that the patient had fatigue and a diffuse erythematous rash. The temperature was 37.7°C. Laboratory evaluation was notable for an absolute eosinophil count of 600 per cubic millimeter (reference range at the other hospital, 0 to 200) and elevated levels on liver-function tests. Computed tomography (CT) of the chest, performed without the intravenous administration of contrast material, reportedly revealed mild, diffuse enlargement of lymph nodes, which were up to 9 mm in diameter in the mediastinum and up to 15 mm in diameter in the porta hepatis. A test of a nasopharyngeal swab for influenza A and B viruses, a rapid test of a throat swab for streptococcal antigen, and tests of the blood for babesia DNA, ehrlichia DNA, hepatitis A virus antibody, hepatitis B virus surface antibody and surface antigen, hepatitis C virus antibody, human immunodeficiency virus (HIV) p24 antigen and antibody, and Lyme disease IgM antibody were negative. The patient was treated with an unknown antibiotic agent, and after 5 days, he was discharged with prescriptions for cetirizine and hydroxyzine. He was scheduled for follow-up with his primary care physician. Copyright © 2018 Massachusetts Medical Society.