Fever, Cough, Back Pain and Fatigue

Robert A. Kyle, MD, and Michael Tomasson, MD

Dr. Kyle: Mayo Clinic College of Medicine
Dr. Tomasson: Washington University School of Medicine, St. Louis, MO

Copyright of the American Society of Hematology, 2006. ISSN: 1931-6860.

This case was reviewed and updated in March 2011 by Dr. Shirley Parker Levine and members of the Teaching Cases Subcommittee.


While examining the patient you find the following:

  • Blood pressure: 170/90
  • Temperature: 102.6o F
  • Pallor of the conjunctivae, mucous membranes and nail beds.
  • Bronchial breath sounds and rales in the right lung base.
  • The liver and spleen are not palpable, and there was no lymphadenopathy.
  • There is no tenderness to palpation over the lumbar spine.
  • There is no pedal edema.

There are no other significant findings on examination.

Have a question or comment about the ASH Teaching Cases? Please e-mail webmaster@hematology.org.