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 Presentation
General 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