A 73-Year-Old Man with Febrile Illness

Introduction. A previously healthy 73-year-old man was brought to Temple University Hospital in Philadelphia, PA by family members after experiencing anorexia and persistently elevated fevers for 4 to 5 days.

Patient history. The patient denied pains other than muscle aches symmetrically in his hands, arms, shoulders, and neck. There was no chest or abdominal pain. His appetite was poor, with little intake of foods and liquids.

His personal medical history includes being a long-time cigarette smoker, but he has no known significant medical conditions. That said, he has rarely had regular medical testing or care. He works on a landscaping crew, which is currently in its busiest season (late spring and early summer). Due to his condition, the patient has not worked for the past week.

His physical examination shows an ill-appearing man weighing 58 kg (127 pounds) who is responsive but lethargic. The patient presented with fever, mild tachycardia, and normotensive vital signs, alongside laboratory abnormalities. The physical examination was notable for dry mucous membranes, mild expiratory wheezes without rales or consolidation, a soft, non-tender abdomen, non-focal neurologic findings, and dry skin without rash on thorough inspection. (Table 1).

Table 1. Vital signs and laboratory findings on presentation