Case 10-2013: A 30-Year-Old Man with Fever, Myalgias, Arthritis, and Rash

A 30-year-old man with a history of IV drug use was admitted to this hospital because of fever, myalgias, polyarthritis, and rash. Results of liver-function tests were notable for mildly elevated hepatic aminotransferase levels and a normal bilirubin level. Presentation of Case Dr. Sheila F. Mitsuma (Medicine): A 30-year-old man with a history of intravenous drug use was admitted to this hospital because of fever, myalgias, arthritis, and rash. The patient was in his usual state of health until 12 days before admission, when 2 days after discharge from a detoxification clinic, he reportedly self-administered heroin intravenously. Two days later, fever, chills, cough, myalgias, anorexia, and malaise occurred and were associated with the gradual onset of joint swelling and pain, an erythematous and nonpruritic rash, and episodes of severe diaphoresis. The joint symptoms first developed in the ankles, and . . .