A 38-year-old woman is hospitalized for fever, night sweats, and a nonproductive cough of 6 weeks' duration. Medical history is significant for Crohn disease. Her only medication is ustekinumab.
On physical examination, temperature is 39.6 °C (103.3 °F), blood pressure is 100/60 mm Hg, pulse rate is 120/min, and respiration rate is 26/min. Crackles are heard in both lung fields. Abdominal examination reveals no hepatosplenomegaly.
Laboratory studies:
Hemoglobin 10 g/dL (100 g/L)
Leukocyte count 3600/µL (3.6 × 109/L)
Platelet count 109,000/µL (109 × 109/L)
Alkaline phosphatase 312 U/L
Alanine aminotransferase 51 U/L
Aspartate aminotransferase 58 U/L
Serum and urinary Histoplasma antigen are negative. Interferon-γ release assay is negative. Chest radiograph is shown.
