The temperature was 37.6☌, the pulse was 68, and the respirations were 18. There was no history of insect bites, residence in a rural area, exposure to cats or other animals, weight loss, cough, abdominal or back pain, or syncope, and she took no medications except for ibuprofen. The patient had recently had a negative tuberculin skin test. Her father had diabetes mellitus and coronary artery disease. One year later, she was in a motor vehicle accident, which resulted in hepatic rupture and other internal injuries that required surgical repair no splenectomy was performed. There was a history suggestive of viral pericarditis at the age of 11 years. She worked in a business firm, did not smoke or use illicit drugs, and consumed little alcohol. The patient had resided primarily in this country during her school years. The fever became more labile, and on the day of admission she felt a left submaxillary lymph node. Shaking chills occurred four days and one day before admission. The patient discontinued ibuprofen on her physician's advice, and her temperature rose progressively as high as 40.6☌, usually increasing at night and peaking in the morning, with night sweats. The prothrombin and partial-thromboplastin times were normal. Hematologic tests were performed ( Table 1). Six days before admission, the patient presented at this hospital with fever and left cervical lymphadenopathy. A test for heterophil agglutinins was negative. Eight days before admission, hematologic tests were performed at another hospital ( Table 1). At about the same time, she began to have a low-grade fever, for which she took ibuprofen. The patient had been well until two weeks earlier (one week after returning from a visit to her native Hong Kong), when she experienced pain and tenderness in the left side of her neck and felt a small lymph node in the cervical region. The most trusted, influential source of new medical knowledge and clinical best practices in the world.Ī 24-year-old Asian woman was admitted to the hospital because of left cervical lymphadenopathy and fever. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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