Case Records of the Massachusetts General Hospital--Weekly Clinicopathological Exercises: Case 11-1990

There was no history of weight change, sore throat, sinus inflammation, cough, sputum production, dysuria, hematochezia, melena, use of medications other than penicillin and aspirin, use of tobacco or alcohol, drug allergy, arthralgia, rheumatic fever or heart murmur, intravenous drug abuse, receipt of transfusions, exposure to ticks or other biting insects, recent dental procedures, hepatitis, tuberculosis or exposure to it, human immunodeficiency virus (HIV) risks on the part of the patient's husband, sexual contact with others, other pregnancies or miscarriages, or recent travel. The urine gave a ++ test for ketones and a negative test for protein; the sediment contained 8 white cells, 15 red cells, and a few bacteria per high-power field.