A Case Report of Fever in an Intravenous Drug User: A Reminder of Cognitive Bias

The practice of medicine requires a widespread knowledge base. Both experienced and newly trained physicians develop heuristics to help sort through the extensive list of diagnoses and the symptoms, signs, and sequelae associated with each one. This case highlights the importance of taking a diagnostic time out when a patient is not improving clinically despite aggressive treatment. Fever is a common symptom encountered in clinical practice, and our case highlights a rare etiology of fever in a young male. This report presents a young male with fever, back pain, and a history of intravenous drug use. It was initially labeled as a straight-forward case of an epidural abscess; however, after a long hospital course, it evolved into a diagnostic dilemma. The patient was ultimately diagnosed with ALK-anaplastic large cell lymphoma, an extremely rare and aggressive malignancy. Diagnosis may have been delayed due to cognitive bias and anchoring on an initial diagnosis suspected to be from an infectious process. It is essential for all practitioners to be mindful of their heuristics in clinical practice and susceptibility to cognitive biases. This can avoid delays in diagnosis and ensure timely treatment of potentially aggressive malignancies.