46-year-old man with recurrent Fever and chills.

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P H O T O Q U I Z
Philip A. Mackowiak, Section Editor
A 46-Year-Old Man With Recurrent Fever and Chills
(See pages for the Answer to the Photo Quiz.)
469–70
A 46-year-old man, an animal skinner at a local meat factory,
was referred to an ambulatory clinic with recurrent fever and
chills. He had been in his usual state of health until a year and
a half previously, when he fell and subsequently developed left
upper quadrant pain. At that time, he noted fever and chills
and was treated with an unknown antimicrobial agent. He did
well for the next 6 months until he again developed fever and
chills associated with low back pain. He was again treated with
antibiotics that produced a resolution of his symptoms. There-
after, he experienced multiple recurrent episodes of fever and
chills lasting for 2–3 weeks that occurred at a frequency of
every 3 months. Due to nonresolving symptoms, he presented
for a further workup. He had no other chronic illnesses and
no history of tuberculosis exposure. He had traveled to the
Philippines and Japan several years prior. His examination
was remarkable for mild left upper quadrant tenderness to
deep palpation. A complete blood cell count was within normal
limits, and his erythrocyte sedimentation rate was 18 mm/h.
Abdominal radiography was performed (Figure 1A).
The patient underwent exploratory laparotomy with splenec-
tomy. A section of the resected spleen is shown (Figure 1B).
Pathological analysis revealed chronic granulomatous inflam-
mation. An acid-fast bacillus stain was negative. A culture of
the spleen is shown (Figure 1C).
What is your diagnosis?
? The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases
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DOI:10.1093/cid/cis130
Figure 1.
A, Abdominal radiograph. B, Resected spleen specimen. C, Tissue culture from the resected spleen.
Clinical Infectious Diseases2012;55(3):413
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