A 58 year-old man with high-grade fever of unknown origin

A 58-year-old male patient, who was a teacher by profession and and is now retired, came to the hospital with a chief complaint of fever since 12 days. The fever was of intermittent type, and was associated with chills and rigors. The fever would not subside with medication. Interestingly, his fever would spike to 105 degrees fahrenheit at 3 AM, and another spike at 3 PM since two days. No history of headache, neck rigidity, sore throat, vomiting, abdominal pain, loose stools, burning micturition, joint pains or significant weight loss. He follows a mixed diet, his bowel and bladder movements are normal ,sleep is adequate but his appetite is reduced. He is a known alcoholic since 20 years, he drinks about 180 ml of Whiskey per day. No history of DM, HTN, TB, Epilepy, Coronary Artery Disease, Cerebrovascular accidents. He has no known history of drug allergies.

General Examination -

Patient is conscious, coherent and co-operative. Moderately build and moderately nourished. No Pallor, Icterus, Cyanosis,Clubbing, Koilonychia, Lymphadenopathy, Edema.

Temperature: 105 degrees fahrenheit
B.P. 120/80 mm Hg
Pulse rate: 98 per min
CVS: S1,S2 heard
Respiratory: Bilateral Air Entry
No Organomegally


Investigations -



Complete Blood Picture:

Ultrasound Report:

Fever Chart: