A 47 year old male had experienced intermittent fevers, chills, and headaches for several weeks. These became more frequent and severe, and over the past two weeks he also noted increased fatigue, nausea, and loss of appetite. Significant past medical history: Congenital kidney defects and chronic pyelonephritis necessitated a renal transplant 18 years before this admission. Prior to transplantation the patient underwent a bilateral nephrectomy and a splenectomy. Since his successful transplant he had been on long-term immunosuppressive agents, and had enjoyed good health.
Physical Exam: Pale and tired appearing. Temperature of 102.6°F. Several small ecchymoses, in various stages of healing, on his legs. CBC (with microscopic differential): RBC: 2.26 x 1012/L; HGB: 7.1 g/dL; HCT: 20.7 %; MCV: 91.6 fL; MCH: 31.4 pg; MCHC: 34.3 g/dL; RDW: 16.2; WBC: 1.1 x 109/L (N 19% L 79 M 2 E 0…
