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“I have a fever and chills.”
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History of Present Illness
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JP is a 34-year-old Caucasian male who is admitted to inpatient oncology service for induction chemotherapy for a recent diagnosis of acute myeloid leukemia (AML). His induction chemotherapy regimen consists of 7 + 3 induction chemotherapy with cytarabine and daunorubicin. He was placed on neutropenic precautions, started on appropriate antimicrobial prophylaxis, and a port was placed for chemotherapy administration. Ten days after the completion of his induction chemotherapy (day 17), he spiked a fever of 38.8°C (101.8°F) and complained of chills and nausea. Details of the hospital course by day are detailed below:
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Appendectomy (10 years ago)
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Father had AML and passed away 8 years ago; mother has hypertension and epilepsy; no siblings
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Married with twins (5 years old). Has never smoked and denies illicit drug use. Drinks alcohol socially. He was previously enlisted in the Navy and is currently a gym teacher at a local elementary school.
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Penicillin (reaction: rash)
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Sertraline 1000 mg PO daily
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Divalproex sodium delayed-release 1000 mg PO BID
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Levetiracetam 1000 mg PO BID
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Sertraline 1000 mg PO daily
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Divalproex sodium delayed-release 1000 mg PO BID
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Levetiracetam 1000 mg PO BID
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Posaconazole delayed-release 300 mg PO BID ×1 day followed by 300 mg PO daily (day 1 start)
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Valacyclovir 500 mg PO BID (day 1 start)
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Levofloxacin 500 mg PO daily (day 1 start)
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Review of Systems (day 17)
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Positive for fever, chills, and nausea; denies vomiting, cough, diarrhea, or abdominal pain
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Physical Examination (day 17)
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Temp 38.8°C, P 105 bpm, RR 16 breaths per minute, BP 112/78 mm Hg, pO2 98%, Ht 5′ 8″, Wt 74 kg
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Male with fatigue and in mild to moderate distress
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PERRLA, EOMI, good dentition, no rhinorrhea or mucositis
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