a complaint of recurrent low-grade fevers

A 35-year old Native-American male presents in the clinic with a complaint of recurrent low-grade fevers, sweating, weakness, muscle pains and a loss of about 10% of his body weight over a 4 month period. The worsening weakness and muscle pain prompted the visit.

The patient reports that he has been working on a bison slaughter line owned by his tribe, and blood and tissue juices often splash in his face or contaminate minor hand and arm injuries. He likes to hunt and fish. He is married and has two children. He eats fairly well, but he has not been as hungry lately. He had rheumatic fever as a child and was in a fairly serious car accident three years earlier, resulting in a leg broken in three places. He feels he was physically fit prior to the past 4 months. He likes to play basketball and softball. He has had all the usual childhood immunizations, but does not see the doctor often.

On physical examination, the patient has a temperature of 101F. He has mildly swollen lymph nodes in the neck and under the arms. He has blood pressure of 136/86, and a normal heart rate without a heart murmur. There is no evidence of acute respiratory or gastrointestinal infection.


  • What would be your diagnosis for this patient? Why?
  • How should this case be treated?
  • What could have been done to prevent this condition?



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