Hey folks, just a quick reminder that this podcast is not meant to be used for medical advice,

just good old-fashioned education and all-patient information has been modified to protect their identity.

Welcome back clinical problem solvers. My name is Arslaan Drakshan. I'm a third-year

internal medicine resident at Johns Hopkins Hospital, and I'm very excited to introduce tonight's show, which will be a clinical unknown with none other than Robbie, who's in the hot seat. So as a quick reminder to the audience, Robbie is completely blinded to this case, and he'll provide his thought process as the information is

presented to him. The goal of these cases is for you to pause and think about the case in parallel

and see your similarities and differences in your thought process to Robbie's discussion.

So tonight's case presenter will be Dr. Fatimo Al-azi. Dr. Alcanazi graduated from Columbia School of Medicine,

and she's currently an internal medicine intern at Johns Hopkins Hospital. She did a fantastic job

taking care of this patient and organizing this case to be presented. So without further ado,

A 76-year-old man presented in December with two weeks of intermittent fevers and chills. He developed fevers and chills a few

days after receiving a corticosteroid injection to his back. He presented to a hospital

where vitals revealed tachycardia and a temperature of 103 Fahrenheit.

His blood pressure was normal.

He had no headaches, cough, sore throat, abdominal pain, diarrhea, rashes, myaljas, back pain, or joint pain.

He had no sick contacts.

His exam, except for tachycardia and fever, was without any focal

findings. Blood cultures times 2, urinalysis, urine culture, and chest x-ray were normal. His lactate was 1.2.

His fever and tachycardia resolved after Tylenol and ivy fluids, and he was discharged from the ED.

His fever returned that night to 102.5 Fahrenheit, but he managed it at home conservatively with Tylenol and a cold washcloth.

His fever resolved by the morning, but again that evening, fever recurred to 103.

He ultimately improved over the next few days, was

a febrile, and was able to return to his job as a college professor. He remained well for the

...