A 31-year-old Caucasian female smoker was admitted to the hospital with a 7-week history of fever associated with night sweats, joint pains, myalgia and nasal congestion. 3 weeks prior to this admission, she was treated with empirical antibiotics for a presumed community-acquired pneumonia as CT scan of the thorax/abdomen/pelvis had revealed subsegmental patchy consolidation of the left lower lobe of the lung. She was readmitted as she continued to have fever despite completing the course of antibiotics prescribed. She had been working in a glass factory for a number of years and had not left the country in recent months. The fever had been going on for a total of 7 weeks, and she had also been experiencing drenching night sweats, joint pains and myalgias, with recent development of dizziness and hearing impairment. She denied any gastrointestinal symptoms.
On examination, she was noted to have conjunctival injection secondary to episcleritis and a non-pruritic maculopapular rash over the upper limbs (figure 1), as well as nodular, tender lesions over her lower limbs. There were no orogenital ulcerations or joint swellings and she was neurologically intact. Routine blood investigations revealed normocytic normochromic anaemia with a high reticulocyte count, a neutrophilic leucocytosis and raised inflammatory markers. Repeat imaging of the chest showed complete resolution of the previous pulmonary consolidation following antibiotic treatment. An MRI of the patient’s brain was performed in view of her audiovestibular symptoms; however, this only revealed longstanding mastoid effusions. After detailed investigations she was started on steroids and became afebrile within a week.
Like
Answers
Save
Share