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Abstract

An 81-year-old gentleman presented with a 2-day history of fevers and chills. On admission, he was febrile, with a body temperature of 37.6°C, tachypneic (respiratory rate: 30 breaths/minute) with 97% oxygen saturation on room air, and hemodynamically stable.ECG showed sinus rhythm at 65 beats/minute, 1st degree AVB and RBBB. His physical examination was unremarkable, except for mild, diffuse abdominal tenderness on palpation.White blood cells count was 11,700 cells/μl (normal range: 3.8-10.5 cells/μl) with 73.4% neutrophils, hemoglobin was 9.4g/dl (14-18 g/dl), platelets were 96,000 K/μl (150-450), erythrocyte sediment rate was 107 mm/hr and C-reactive protein was 8.66 mg/dl (<0.5). Creatinine was 1.91 mg/dl (0.72-1.18mg/dl) and urea 66 mg/dl (17-43 mg/ dl). Urinalysis demonstrated proteinuria and increased RBCs.