Table A: Summary of the Patient’s Diagnostic Workup and Results for Fever of Unknown Origin Per Hospital Admission. Pertinent findings include normal CK, negative ANA and anti-Jo, and elevated ferritin.
First Presentation / Second Presentation / Third PresentationGeneral testing or other /
- White Blood Cell (WBC): 7.0x109/L
- Hemoglobin (Hgb): 10.8 g/dL
- Hematocrit (Hct): 33.2%
- Platelet (Plt): 340x109/L
- Sodium (Na): 128 mmol/L
- Potassium (K): 3.9 mmol/L
- Chloride (Cl): 99 mmol/L
- Bicarbonate (CO2): 22 mmol/L
- Creatinine (Cr): 0.9 mg/dL
- Urea Nitrogen (BUN): 10 mg/dL
- Glucose: 98 mg/dL
- Thyroid Stimulating Hormone (TSH): 0.20 mIU/mL
- Erythrocyte sedimentation rate (ESR): 97 mm/hr
- C-reactive protein (CRP): 5.7 mg/dL
- Creatine kinase (CK): 44 units/liter
- Aldolase: 9.4 U/L (normal: <7.7)
- Lactate dehydrogenase (LDH): 301 U/L
- Aspartate aminotransferase (AST): 59 U/L
- Alanine Aminotransferase (ALT): 59 U/L
- Ferritin: 9454 ng/mL
- Natural killer cell function assay: Normal
- Albumin: 3.1 g/dL
- WBC: 4.8x109/L
- Hgb: 11.1 g/dL
- Hct: 34.3%
- Plt: 196x109/L
- Na: 134 mmol/L
- K: 3.4 mmol/L
- Cl: 102 mmol/L
- CO2: 20 mmol/L
- Cr: 1.0 mg/dL
- BUN: 8 mg/dL
- Glucose: 117 mg/dL
- TSH: 0.90 mIU/mL
- ESR: 17mm/hr
- CRP: 4.0mg/dL
- CK: 36 U/L
- Aldolase: 8.5 U/L (normal: <7.7)
- LDH: 247 U/L
- AST: 134 U/L
- ALT: 143 U/L
- Ferritin: 2351 ng/mL
- WBC: 6.0x109/L
- Hgb: 12.3 g/dL
- Hct: 37.2%
- Plt: 246x109/L
- Na: 127 mmol/L
- K: 4.2 mmol/L
- Cl: 101 mmol/L
- CO2: 19 mmol/L
- Cr: 1.2 mg/dL
- BUN: 13 mg/dL
- Glucose: 102 mg/dL
- TSH: 0.84mIU/mL
- ESR: 19mm/hr
- CRP:12mg/dL
- CK: 134 U/L
- Aldolase: 6.6 U/L
- LDH: 288 U/L
- AST: 82 U/L
- ALT:59 U/L
- Ferritin: 4925 ng/mL
Infectious /
- Human immunodeficiency virus antibody: Negative
- Blood cultures: No growth 4/4 bottles
- Respiratory culture: 3+ normal respiratory flora
- Sputum acid fast bacilli cultures: 3/3 stains negative for AFB, cultures no growth after 45 days
- Sputum Pneumocystitis stain: Negative
- Hepatitis B surface antibody: Positive
- Hepatitis B surface antigen: Negative
- Hepatitis B core antibody IgM: Negative
- Hepatitis B core IgG: positive
- Hepatitis C antibody: Negative
- Hepatitis B virus DNA: Not detected
- Hepatitis B E Antigen: Non-reactive
- Hepatitis B E Antibody: Reactive
- Histoplasma antigen: Negative
- Coccidioides complement fixation: Negative
- Coccidioides immunodiffusion: Negative
- Cyclomegavirus PCR: Not detected
- Epstein-barr Virus: IgG Positive, IgM Negative
- Legionella antigen, urine: Not detected
- Coxiella burnetii: IgG negative, IgM negative
- Mycoplasma antibody: IgG Positive, IgM Negative
- Toxoplasma antibody: IgG positive, IgM negative
- Liver biopsy: CMV DNA not detected, EBV DNA not detected
- Hepatitis C RNA PCR: Not detected
- Herpes simplex virus (HSV): HSV-1 IgG Positive, HSV-2 IgG Positive, HSV IgM Negative
- Varicella zoster: IgG Positive, IgM Negative
- Chlamydia pneumoniae: IgG Negative, IgM Negative
- Chlamydia trachomatis: IgG Negative, IgM Negative
- Chlamydia psittaci: IgG Negative, IgM Negative
- Bartonella henselae: IgG negative, IgM negative
- Bartonella quintana: IgG negative, IgM negative
- Respiratory virus PCR (Influenza A, Influenza B, RSV, Parainfluenza 1, Parainfluenza 2, Parainfluenza 3, Metapneumovirus, Rhinovirus, Adenovirus): Not detected
- Throat culture: Negative for Streptococcus pyogenes, Streptococcus dysgalactiae subsp. equisimilis
- Neisseria gonorrhoeae urine: Negative
- Brucella IgG Negative, IgM Negative
- Parvovirus B19 Antibody IgG: Equivocal
- Lyme disease IgG: Negative, IgM Negative
- Toxoplasma gondii: IgG Positive, IgM Negative
- Stool studies: no ova, cysts, or larvae; no protozoa; no leukocytes or RBCs
- Blood cultures: No growth in 4/4 bottles
- Strongyloides antibody: IgG Negative
Non-infectious inflammatory /
- Anti-nuclear antibody (ANA): Negative
- Complement C3: 128 mg/dL
- Complement C4: 20.4 mg/dL
- Rheumatoid factor (RF): Negative
- Anti-cyclic citrullinated peptide: Negative
- Anti-smooth muscle antibody: Negative
- Anti-mitochondrial antibody, M2: 0.1 units (borderline)
- Anti-liver-kidney microsome IgG antibody: Negative
- Anti-Jo1 antibody: Negative
- Hemochromatosis genotype: Normal variant
- Soluble interleukin 2-receptor level: 1630 units/mL
- Alpha-1 antitrypsin level: Normal
- c-ANCA: Negative
- p-ANCA: Negative
- Myositis antibody panel (MI-2, PL-7, PL-12, EJ OJ, SRP, KU, U2 SNRNP): Negative
Malignancy /
- Serum protein immunofixation electrophoresis: Normal
- Urine protein immunofixation electrophoresis: Normal
- Paraneoplasitc autoantibody evaluation: Negative