The clinical and diagnostic workup of fever of unknown origin (FUO) is key in the treatment of patients on the internal medicine service. In this article, the authors present a case of fever of unknown origin, walk through the differential diagnosis, explain the laboratory testing ordered in the workup of the patient as well as the resulting values of said testing, and discuss the pathophysiology and diagnostic criteria for the diagnosis of Pel-Ebstein fever. The authors also discuss a clinical pearl when working with electronic health records to ensure that the needs of the patient in question are met.

The authors present a unique case of schizoaffective disorder exacerbation, complicated by substance misuse, rhabdomyolysis, and acute renal injury. The patient had been recently released from jail and was not on any psychiatric medications aside. His family reported bizarre behavior involving the patient spending a significant amount of time in an outdoor hot tub exposed to extreme heat, which the patient justified as necessary to protect him from snakes. The patient was diagnosed with severe dehydration and rhabdomyolysis, both of which were managed by the primary care team in a hospital setting with specialist input from the psychiatry and renal departments. The patient exhibited paranoid ideations toward the medical team and at times was agitated and combative. Resolution of this distrust was pivotal to successful treatment and was made possible through trilateral communication between the patient, the police officers, and medical staff.

No abstract