title: Fever, chills, and weakness in a 61-year-old man.
abstract: A 61-year-old man presented to the emergency department of a community hospital with a 2-week history of fever, chills, and sudden extreme weakness of his right arm and lower extremities. He also had a cough, shortness of breath, nausea, abdominal pain, diarrhea, and myalgia. Though initially alert and cooperative, he quickly became unresponsive. In addition, he had hyponatremia, renal insufficiency, and compromised cardiopulmonary function. He was admitted to the intensive care unit for suspected bacterial infection and was started on broad-spectrum antibiotics. Chest radiograph revealed miliary infiltrates consistent with infectious emboli or metastatic carcinoma. Despite intensive resuscitation, the patient died 36 hours after admission. At autopsy multiple nodular lesions were observed on gross examination of the lungs, perihilar and paratracheal lymph nodes, and liver. Microscopic sections of the lung (Figure 1) and brain (Figures 2 and 3) are shown.
authors.affiliation: Department of Pathology, Louisiana State University Health Sciences Center, Shreveport, USA.
authors.forename: Eric Xueying
authors.initials: EX
authors.lastname: Wei
authors.forename: Yeong-Ju
authors.initials: YJ
authors.lastname: Dancer
authors.forename: Diana M
authors.initials: DM
authors.lastname: Veillon
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Linscott
authors.forename: Kevin
authors.initials: K
authors.lastname: Dowden
authors.forename: Marjorie
authors.initials: M
authors.lastname: Fowler
authors.forename: James D
authors.initials: JD
authors.lastname: Cotelingam
mesh_terms: D001759:Blastomycosis / Q000150:complications / Q000473:pathology*; D001921:Brain / Q000473:pathology; D023341:Chills / Q000382:microbiology; D005334:Fever / Q000382:microbiology; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000382:microbiology; D020096:Zygomycosis / Q000150:complications / Q000473:pathology*