An 83-year-old man visited the emergency department with a high-grade fever that lasted for several hours. His past medical history was remarkable for cerebral infarction, prostate cancer, diabetes mellitus, and atrial ventricular block. He was taking aspirin, clopidogrel, bicalutamide, rabeprazole, glimepiride, teneligliptin, and isosorbide sulfate. Physical examination revealed that the patient was diaphoretic but not in acute distress. His body temperature was 40.2°C, but other vital signs were normal. He was neither anemic nor icteric. Auscultation revealed that his chest was clear, and heart sounds were normal. His abdomen was soft, non-tender, and non-distended, without hepatosplenomegaly or costovertebral angle tenderness. Results of laboratory analyses revealed mild leukocytosis (leukocytes, 7790/μL with 94% neutrophils) and slight abnormalities in liver function (aspartate transaminase, 26 U/L; alanine transaminase, 106 U/L; alkaline phosphatase, 465 U/L; gamma-glutamyl transferase, 142 U/L; and total bilirubin, 1.7 mg/dL). Urinalysis revealed positive results for nitrate and high levels of white blood cells (10-19 per high-power field). Noncontrast computed tomography (CT) of the chest and abdomen revealed no remarkable findings indicating the cause of fever, other than urinary retention (Figure A).
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-Kai Uehara, MDa,b, Yukinori Harada, MDa,c
