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Fever, night sweats, and a hepatic mass
  1. J M Levsky,
  2. D T Farkas,
  3. A Narula
  1. Department of Surgery, Jacobi Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; jlevskyaecom.yu.edu
  1. Correspondence to:
    Dr J M Levsky
    jlevskyaecom.yu.edu

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Question

A 41 year old Hispanic man with no significant medical history presented with a two month history of fever, chills, and night sweats. He denied nausea, vomiting, diarrhoea, weight loss, cough, and dysuria. On examination he was in no acute distress, with a temperature of 38.2°C (100.8F), and normal vital signs. He had mild right upper quadrant tenderness and an enlarged liver. Initial laboratory data were remarkable except for microcytic anaemia and an erythrocyte sedimentation rate of 95. The patient was admitted to the hospital to investigate his recurring fevers. Although he had temperatures as high as 40.3°C (104.5F), his infectious workup was negative. Bacterial cultures of his blood, urine, and sputum were negative, as were fungal cultures. Serology for entamoeba, echinococcus, and human immunodeficiency virus were also negative. In the course of his workup he had a computed tomography scan of the abdomen. How can this image explain the clinical scenario?

See page 1773 for answer

Figure 1

Contrast enhanced computed tomography image of the liver.

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