Extract

A 75-year-old man with chronic heart failure and chronic obstructive pulmonary disease visited our emergency outpatient unit because of fever of 38 °C and dyspnea. His vital signs were as follows: blood pressure 150/68 mmHg; pulse 103 beats/min, regular; respiratory rate 26 breaths/min; temperature 38.6 °C; and SpO2 90% (without supplemental oxygen). A systolic murmur (Levine scale 2/6) was heard at the apex. Coarse crackles were auscultated over the lung bases bilaterally. There were no other abnormal physical findings. Blood tests showed a white blood cell count of 12.8 × 109/L and C-reactive protein of 9.8 mg/dl. The urinalysis results were normal. Bilateral pleural effusions were detected on a chest radiograph and computed tomography (CT) scan, but no infiltrative shadows were observed. The cause of fever was not identified on transesophageal echocardiography, abdominal CT or bacterial culture from urine. He was hospitalized, and received ceftriaxone on the suspicion of sepsis for which a focus of infection could not be identified. He also received diuretic therapy for congestive heart failure.

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