Correct!
5. All of the above

The patient is an immunocompromised host with a fever of unknown origin and no clear indication from the history and physical examination as to the source of the fever. The reasoning for the blood cultures and sputum for AFB and tuberculosis culture is relativity straight forward and most would do a lumbar puncture because of the headache.

Below is the laboratory evaluation:
CBC

• White blood cell count of 8.1 X103 cells/uL
• Hemoglobin of 10.9 gm/dL
• Hematocrit of 31%
• Platelet count of 252 x 103 /uL

Chemistry

• Creatinine of 1.24 mg/dL
• Bicarbonate 23 mmol/L
• Anion gap 7 mmol/L

Viral Serology

• Positive Mycoplasma IgM

Cerebrospinal Fluid

• RBC 575 cells
• total nucleated cell count 0 cells
• glucose 44 mg/dl
• total protein 46 mg/dl
• Negative Herpes Simplex Virus and enterovirus polymerase chain reaction (PCR)
• negative gram stain

Induced Acid Fast Bacilli Culture + Stain

• 3/3 no detection of mycobacterium with PCR
• Culture and Stain pending at 14 days.

Blood cultures no growth, preliminary.
Erythrocyte Sedimentation Rate 79 mm/hr
C-Reactive Protein 5.9 mg/dL
Lactate 1.4 mmol/L

Her chest Computerized Tomography (CT) is shown below.

Figure 1. Thoracic CT in lung windows (A) and soft tissue windows (B).

1. Active Tuberculosis (TB)
2. Cryptococcus
3. Nontuberculous mycobacterium disease
4. Pulmonary Kaposi sarcoma and/or lymphoma and/or lung cancer
5. Sarcoidosis

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